WO2022038211A2 - Utilisation d'inhibiteurs de a1cf pour traiter une infection par le virus de l'hépatite b - Google Patents

Utilisation d'inhibiteurs de a1cf pour traiter une infection par le virus de l'hépatite b Download PDF

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WO2022038211A2
WO2022038211A2 PCT/EP2021/072985 EP2021072985W WO2022038211A2 WO 2022038211 A2 WO2022038211 A2 WO 2022038211A2 EP 2021072985 W EP2021072985 W EP 2021072985W WO 2022038211 A2 WO2022038211 A2 WO 2022038211A2
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nucleic acid
acid molecule
a1cf
hbv
nucleosides
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PCT/EP2021/072985
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WO2022038211A3 (fr
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Dennis Jul HANSEN
Souphalone LUANGSAY
Alan James MUELLER-BRECKENRIDGE
Lykke PEDERSEN
Johanna Marie WALTHER
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F. Hoffmann-La Roche Ag
Hoffmann-La Roche Inc.
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Priority to CN202180051604.7A priority Critical patent/CN116157522A/zh
Priority to EP21765633.9A priority patent/EP4200419A2/fr
Priority to JP2023512305A priority patent/JP2023538630A/ja
Publication of WO2022038211A2 publication Critical patent/WO2022038211A2/fr
Publication of WO2022038211A3 publication Critical patent/WO2022038211A3/fr
Priority to US18/171,130 priority patent/US20230257748A1/en

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    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N15/00—Mutation or genetic engineering; DNA or RNA concerning genetic engineering, vectors, e.g. plasmids, or their isolation, preparation or purification; Use of hosts therefor
    • C12N15/09—Recombinant DNA-technology
    • C12N15/11—DNA or RNA fragments; Modified forms thereof; Non-coding nucleic acids having a biological activity
    • C12N15/113—Non-coding nucleic acids modulating the expression of genes, e.g. antisense oligonucleotides; Antisense DNA or RNA; Triplex- forming oligonucleotides; Catalytic nucleic acids, e.g. ribozymes; Nucleic acids used in co-suppression or gene silencing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/54—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic compound
    • A61K47/549—Sugars, nucleosides, nucleotides or nucleic acids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
    • A61K48/0008—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'non-active' part of the composition delivered, e.g. wherein such 'non-active' part is not delivered simultaneously with the 'active' part of the composition
    • A61K48/0025—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'non-active' part of the composition delivered, e.g. wherein such 'non-active' part is not delivered simultaneously with the 'active' part of the composition wherein the non-active part clearly interacts with the delivered nucleic acid
    • A61K48/0033—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'non-active' part of the composition delivered, e.g. wherein such 'non-active' part is not delivered simultaneously with the 'active' part of the composition wherein the non-active part clearly interacts with the delivered nucleic acid the non-active part being non-polymeric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A61P31/20—Antivirals for DNA viruses
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2310/00—Structure or type of the nucleic acid
    • C12N2310/10—Type of nucleic acid
    • C12N2310/11—Antisense

Definitions

  • the present invention relates to A1CF inhibitors for use in treating a hepatitis B virus (HBV) infection, in particular a chronic HBV infection.
  • the invention in particular relates to the use of A1CF inhibitors for destabilizing cccDNA, such as HBV cccDNA.
  • the invention also relates to nucleic acid molecules, such as oligonucleotides including siRNA, shRNA and antisense oligonucleotides, that are complementary to A1 CF, and capable of reducing the expression of A1CF.
  • a pharmaceutical composition and its use in the treatment of a HBV infection is also comprised.
  • Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV), a small hepatotropic virus that replicates through reverse transcription.
  • Chronic HBV infection is a key factor for severe liver diseases such as liver cirrhosis and hepatocellular carcinoma.
  • Current treatments for chronic HBV infection are based on administration of pegylated type 1 interferons or nucleos(t)ide analogues, such as lamivudine, adefovir, entecavir, tenofovir disoproxil, and tenofovir alafenamide, which target the viral polymerase, a multifunctional reverse transcriptase.
  • Treatment success is usually measured as loss of hepatitis B surface antigen (HBsAg).
  • cccDNA covalently closed circular DNA
  • A1CF (APOBEC1 complementation factor) is a component of the apolipoprotein B mRNA editing enzyme complex which is responsible for the posttranscriptional editing of a CAA codon for Gin to a UAA codon for stop in apolipoprotein B mRNA.
  • the introduction of a stop codon into apolipoprotein B mRNA alters lipid metabolism in the gastrointestinal tract.
  • the editing enzyme complex comprises a minimal core composed of the cytidine deaminase APOBEC-1 (Apolipoprotein B mRNA editing enzyme 1) and a complementation factor encoded by the A1CF gene.
  • the A1 CF protein has three non-identical RNA recognition motifs and belongs to the hnRNP R family of RNA-binding proteins. It binds to apolipoprotein B mRNA and is probably responsible for docking the catalytic subunit, APOBEC1 , to the mRNA to allow it to deaminate its target cytosine (see Chester et al., EMBO J. 2003 Aug 1 ;22(15):3971 -82). Many reports on the apolipoprotein B mRNA editing enzyme complex are focused on the cytidine deaminase APOBEC1, rather than on the APOBEC1 complementation factor. It has been shown that APOBEC1 does not only edit apolipoprotein B mRNA, but also viral genomes including HBV.
  • Renard et al. showed that mouse APOBEC1 edited HBV in vivo (Renard et al., J Mol Biol. 2010 Jul 16;400(3):323-34. doi: 10.1016/j.jmb.2010.05.029).
  • rat APOBEC1 did not inhibit HBV DNA production (Rosier et al., Hepatology. 2005 Aug;42(2):301-9).
  • APOBEC1 impacted replication of HBV DNA. Specifically, it was shown that an increased expression of APOBEC1 resulted in a decreased amount of HBV DNA (Gonzalez et al., Retrovirology. 2009 Oct 21 ;6:96. doi: 10.1186/1742-4690-6-96).
  • A1CF has never been identified as a cccDNA dependency factor in the context of cccDNA stability and maintenance, nor have molecules inhibiting A1CF ever been suggested as cccDNA destabilizers for the treatment of HBV infection.
  • oligonucleotides potentially related to the regulation of A1CF expression are suggested in WO 2016/142948.
  • WO 2016/142948 relates to the alteration of splicing of a number of listed targets including A1CF, to produce alternative splice variants.
  • the oligonucleotides are however decoy oligonucleotides encoding splicing-factor binding sites and does therefore not bind to the targets as such.
  • WO 2016/142948 also mentions a list of treatments including cancer, inflammation, immunological disorders, neurodegeneration, Alzheimer disease, Parkinson, viral infections (HIV, HSV, HBV). There are however no specific examples of oligonucleotides targeting A1CF nor their use in HBV.
  • the present invention shows that there is an association between the inhibition of A1CF and reduction of of the amount of cccDNA in an HBV infected cell, which is relevant in the treatment of HBV infected individuals.
  • An objective of the present invention is to identify A1CF inhibitors which reduce the amount of cccDNA in an HBV infected cell. Such A1CF inhibitors can be used in the treatment of HBV infection.
  • the present invention further identifies novel nucleic acid molecules, which are capable of inhibiting the expression of A1 CF in vitro and in vivo.
  • the present invention relates to oligonucleotides targeting a nucleic acid capable of modulating the expression of A1CF and to treat or prevent diseases related to the functioning of the A1CF.
  • the invention provides an A1CF inhibitor for use in the treatment and/or prevention of Hepatitis B virus (HBV) infection.
  • an A1CF inhibitor capable of reducing the amount of HBV cccDNA and/or HBV pre-genomic RNA (pgRNA) is useful.
  • pgRNA HBV pre-genomic RNA
  • Such an inhibitor is advantageously a nucleic acid molecule of 12 to 60 nucleotides in length, which is capable of reducing A1CF mRNA.
  • the invention relates to a nucleic acid molecule of 12-60 nucleotides, such as of 12-30 nucleotides, comprising a contiguous nucleotides sequence of at least 10 nucleotides, in particular of 16 to 20 nucleotides, which is at least 90% complementary, such as fully complementary to a mammalian A1CF, e.g. a human A1CF, a mouse A1CF or a cynomolgus monkey A1CF.
  • a nucleic acid molecule is capable of inhibiting the expression of A1CF in a cell expressing A1CF. The inhibition of A1CF allows for a reduction of the amount of cccDNA present in the cell.
  • the nucleic acid molecule can be selected from a single stranded antisense oligonucleotide, a double stranded siRNA molecule or a shRNA nucleic acid molecule (in particular a chemically produced shRNA molecules).
  • a further aspect of the present invention relates to single stranded antisense oligonucleotides or siRNA’s that inhibit the expression and/or activity of A1CF.
  • modified antisense oligonucleotides or modified siRNAs comprising one or more 2’ sugar modified nucleoside(s) and one or more phosphorothioate linkage(s), which reduce A1CF mRNA are advantageous.
  • the invention provides pharmaceutical compositions comprising the A1CF inhibitor of the present invention, such as the antisense oligonucleotide or siRNA of the invention and a pharmaceutically acceptable excipient.
  • the invention provides methods for in vivo or in vitro modulation of A1CF expression in a target cell which is expressing A1 CF, by administering an A1 CF inhibitor of the present invention, such as an antisense oligonucleotide or composition of the invention in an effective amount to said cell.
  • an A1 CF inhibitor of the present invention such as an antisense oligonucleotide or composition of the invention in an effective amount to said cell.
  • the A1CF expression is reduced by at least 50%, or at least 60%, or at least 70%, or at least 80%, in the target cell compared to the level without any treatment or treated with a control.
  • the target cell is infected with HBV and the cccDNA in an HBV infected cell is reduced by at least 50%, or at least 60%, or at least 70%, in the HBV infected target cell compared to the level without any treatment or treated with a control. In some embodiments, the target cell is infected with HBV and the pgRNA in an HBV infected cell is reduced by at least 50%, or at least 60%, in the HBV infected target cell compared to the level without any treatment or treated with a control.
  • the invention provides methods for treating or preventing a disease, disorder or dysfunction associated with in vivo activity of A1CF comprising administering a therapeutically or prophylactically effective amount of the an A1 CF inhibitor of the present invention, such as the antisense oligonucleotide or siRNA of the invention to a subject suffering from or susceptible to the disease, disorder or dysfunction.
  • a disease, disorder or dysfunction associated with in vivo activity of A1CF comprising administering a therapeutically or prophylactically effective amount of the an A1 CF inhibitor of the present invention, such as the antisense oligonucleotide or siRNA of the invention to a subject suffering from or susceptible to the disease, disorder or dysfunction.
  • conjugates of nucleic acid molecules of the invention and pharmaceutical compositions comprising the molecules of the invention are conjugates targeting the liver are of interest, such as GalNAc clusters.
  • Figure 1 A-L Illustrates exemplary antisense oligonucleotide conjugates, wherein the oligonucleotide is represented by the term “Oligonucleotide” and the asialoglycoprotein receptor targeting conjugate moieties are trivalent N-acetylgalactosamine moieties.
  • Compounds in Fig. 1A-D comprise a di-lysine brancher molecule, a PEG3 spacer and three terminal GalNAc carbohydrate moieties.
  • Fig. 1A Fig. 1 A-1 and Fig. 1A-2 show two different diastereoisomers of the same compound
  • Fig. 1 B Fig. 1 B-1 and Fig.
  • Fig. 1 B-2 show two different diastereoisomers of the same compound
  • the oligonucleotide is attached directly to the asialoglycoprotein receptor targeting conjugate moiety without a linker.
  • Fig. 1C shows two different diastereoisomers of the same compound
  • Fig. 1D shows two different diastereoisomers of the same compound
  • the oligonucleotide is attached to the asialoglycoprotein receptor targeting conjugate moiety via a C6 linker.
  • Fig. 1E-K comprise a commercially available trebler brancher molecule and spacers of varying length and structure and three terminal GalNAc carbohydrate moieties.
  • Fig. 1B and Fig. 1D are also termed GalNAc2 or GN2 herein, without and with C6 linker respectively.
  • a pool of a specific antisense oligonucleotide conjugate can therefore contain only one of the two different diastereoisomers, or a pool of a specific antisense oligonucleotide conjugate can contain a mixture of the two different diastereoisomers.
  • hepatitis B virus infection or “HBV infection” is commonly known in the art and refers to an infectious disease that is caused by the hepatitis B virus (HBV) and affects the liver.
  • a HBV infection can be an acute or a chronic infection.
  • Chronic hepatitis B virus (CHB) infection is a global disease burden affecting 248 million individuals worldwide. Approximately 686,000 deaths annually are attributed to HBV-related end-stage liver diseases and hepatocellular carcinoma (HCC) (GBD 2013; Schweitzer et al., Lancet. 2015 Oct 17;386(10003):1546-55).
  • CHB infection is not a homogenous disease with singular clinical presentation. Infected individuals have progressed through several phases of CHB-associated liver disease in their life; these phases of disease are also the basis for treatment with standard of care (SOC). Current guidelines recommend treating only selected CHB-infected individuals based on three criteria - serum ALT level, HBV DNA level, and severity of liver disease (EASL, 2017). This recommendation was due to the fact that SOC i.e.
  • nucleos(t)ide analogs and pegylated interferon-alpha (PEG-IFN)
  • NAs nucleos(t)ide analogs
  • PEG-IFN pegylated interferon-alpha
  • HBsAg hepatitis B surface antigen
  • cccDNA covalently closed circular DNA
  • HBsAg subviral particles outnumber HBV virions by a factor of 103 to 105 (Ganem & Prince, N Engl J Med. 2004 Mar 11 ;350(11 ):1118- 29); its excess is believed to contribute to immunopathogenesis of the disease, including inability of individuals to develop neutralizing anti-HBs antibody, the serological marker observed following resolution of acute HBV infection.
  • HBV infection refers to “chronic HBV infection”.
  • the term encompasses infection with any HBV genotype.
  • the patient to be treated is infected with HBV genotype A.
  • the patient to be treated is infected with HBV genotype B.
  • the patient to be treated is infected with HBV genotype C.
  • the patient to be treated is infected with HBV genotype D.
  • the patient to be treated is infected with HBV genotype E.
  • the patient to be treated is infected with HBV genotype F.
  • the patient to be treated is infected with HBV genotype G.
  • the patient to be treated is infected with HBV genotype H.
  • the patient to be treated is infected with HBV genotype I.
  • cccDNA covalently closed circular DNA
  • cccDNA is the viral genetic template of HBV that resides in the nucleus of infected hepatocytes, where it gives rise to all HBV RNA transcripts needed for productive infection and is responsible for viral persistence during natural course of chronic HBV infection (Locarnini & Zoulim, Antivir Ther. 2010;15 Suppl 3:3-14. doi: 10.3851/IMP1619).
  • Acting as a viral reservoir, cccDNA is the source of viral rebound after cessation of treatment, necessitating long term, often lifetime treatment.
  • PEG-IFN can only be administered to a small subset of CHB due to its various side effects.
  • the term “compound” means any molecule capable of inhibition A1CF expression or activity.
  • Particular compounds of the invention are nucleic acid molecules, such as RNAi molecules or antisense oligonucleotides according to the invention or any conjugate comprising such a nucleic acid molecule.
  • the compound may be a nucleic acid molecule targeting A1CF, in particular an antisense oligonucleotide or a siRNA.
  • oligonucleotide as used herein is defined as it is generally understood by the skilled person as a molecule comprising two or more covalently linked nucleosides. Such covalently bound nucleosides may also be referred to as nucleic acid molecules or oligomers.
  • the oligonucleotides referred to in the description and claims are generally therapeutic oligonucleotides below 70 nucleotides in length.
  • the oligonucleotide may be or comprise a single stranded antisense oligonucleotide, or may be another nucleic acid molecule, such as a CRISPR RNA, a siRNA, shRNA, an aptamer, or a ribozyme.
  • Therapeutic oligonucleotide molecules are commonly made in the laboratory by solid-phase chemical synthesis followed by purification and isolation.
  • shRNA are however often delivered to cells using lentiviral vectors from which they are then transcribed to produce the single stranded RNA that will form a stem loop (hairpin) RNA structure that is capable of interacting with the RNA interference machinery (including the RNA-induced silencing complex (RISC)).
  • the shRNA is chemically produced shRNA molecules (not relying on cell based expression from plasmids or viruses).
  • the oligonucleotide of the invention is man-made, and is chemically synthesized, and is typically purified or isolated.
  • the oligonucleotide of the invention is a shRNA transcribed from a vector upon entry into the target cell.
  • the oligonucleotide of the invention may comprise one or more modified nucleosides or nucleotides.
  • the oligonucleotide of the invention comprises or consists of 10 to 70 nucleotides in length, such as from 12 to 60, such as from 13 to 50, such as from 14 to 40, such as from 15 to 30, such as from 16 to 25, such as from 16 to 22, such as from 16 to 20 contiguous nucleotides in length.
  • the oligonucleotide of the present invention in some embodiments, may have a length of 12 to 25 nucleotides.
  • the oligonucleotide of the present invention in some embodiments, may have a length of 15 to 22 nucleotides.
  • the oligonucleotide or contiguous nucleotide sequence thereof comprises or consists of 24 or less nucleotides, such as 22, such as 20 or less nucleotides, such as 18 or less nucleotides, such as 14, 15, 16 or 17 nucleotides. It is to be understood that any range given herein includes the range endpoints. Accordingly, if a nucleic acid molecule is said to include from 12 to 25 nucleotides, both 12 and 25 nucleotides are included.
  • the contiguous nucleotide sequence comprises or consists of 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 or 22 contiguous nucleotides in length
  • the olignucleotide(s) are for modulating the expression of a target nucleic acid in a mammal.
  • the nucleic acid molecules such as for siRNAs, shRNAs and antisense oligonucleotides, are typically for inhibiting the expression of a target nucleic acid(s).
  • oligonucleotide is selected from a RNAi agent, such as a siRNA or shRNA.
  • a RNAi agent such as a siRNA or shRNA.
  • the oligonucleotide is a single stranded antisense oligonucleotide, such as a high affinity modified antisense oligonucleotide interacting with RNase H.
  • the oligonucleotide of the invention may comprise one or more modified nucleosides or nucleotides, such as 2’ sugar modified nucleosides.
  • the oligonucleotide comprises phosphorothioate internucleoside linkages.
  • the oligonucleotide may be conjugated to non-nucleosidic moieties (conjugate moieties).
  • a library of oligonucleotides is to be understood as a collection of variant oligonucleotides.
  • the purpose of the library of oligonucleotides can vary.
  • the library of oligonucleotides is composed of oligonucleotides with overlapping nucleobase sequence targeting one or more mammalian A1 CF target nucleic acids with the purpose of identifying the most potent sequence within the library of oligonucleotides.
  • the library of oligonucleotides is a library of oligonucleotide design variants (child nucleic acid molecules) of a parent or ancestral oligonucleotide, wherein the oligonucleotide design variants retaining the core nucleobase sequence of the parent nucleic acid molecule.
  • Antisense oligonucleotides are a library of oligonucleotide design variants (child nucleic acid molecules) of a parent or ancestral oligonucleotide, wherein the oligonucleotide design variants retaining the core nucleobase sequence of the parent nucleic acid molecule.
  • antisense oligonucleotide or “ASO” as used herein is defined as oligonucleotides capable of modulating expression of a target gene by hybridizing to a target nucleic acid, in particular to a contiguous sequence on a target nucleic acid.
  • the antisense oligonucleotides are not essentially double stranded and are therefore not siRNAs or shRNAs.
  • the antisense oligonucleotides of the present invention are single stranded.
  • single stranded oligonucleotides of the present invention can form hairpins or intermolecular duplex structures (duplex between two molecules of the same oligonucleotide), as long as the degree of intra or inter self complementarity is less than 50% across of the full length of the oligonucleotide.
  • the single stranded antisense oligonucleotide of the invention does not contain RNA nucleosides, since this will decrease nuclease resistance.
  • the oligonucleotide of the invention comprises one or more modified nucleosides or nucleotides, such as 2’ sugar modified nucleosides. Furthermore, it is advantageous that the nucleosides which are not modified are DNA nucleosides.
  • RNA interference (RNAi) molecule refers to short double-stranded oligonucleotide containing RNA nucleosides and which mediates targeted cleavage of an RNA transcript via the RNA-induced silencing complex (RISC), where they interact with the catalytic RISC component argonaute.
  • RISC RNA-induced silencing complex
  • the RNAi molecule modulates, e g., inhibits, the expression of the target nucleic acid in a cell, e.g. a cell within a subject, such as a mammalian subject.
  • RNAi molecules includes single stranded RNAi molecules (Lima at al 2012 Cell 150: 883) and double stranded siRNAs, as well as short hairpin RNAs (shRNAs).
  • the oligonucleotide of the invention or contiguous nucleotide sequence thereof is a RNAi agent, such as a siRNA.
  • small interfering ribonucleic acid refers to a small interfering ribonucleic acid RNAi molecule. It is a class of double-stranded RNA molecules, also known in the art as short interfering RNA or silencing RNA.
  • siRNAs typically comprise a sense strand (also referred to as a passenger strand) and an antisense strand (also referred to as the guide strand), wherein each strand are of 17 to 30 nucleotides in length, typically 19 to 25 nucleosides in length, wherein the antisense strand is complementary, such as at least 95% complementary, such as fully complementary, to the target nucleic acid (suitably a mature mRNA sequence), and the sense strand is complementary to the antisense strand so that the sense strand and antisense strand form a duplex or duplex region.
  • siRNA strands may form a blunt ended duplex, or advantageously the sense and antisense strand 3’ ends may form a 3’ overhang of e.g.
  • both the sense strand and antisense strand have a 2nt 3’ overhang.
  • the duplex region may therefore be, for example 17 to 25 nucleotides in length, such as 21 to 23 nucleotide in length.
  • siRNAs typically comprise modified nucleosides in addition to RNA nucleosides.
  • the siRNA molecule may be chemically modified using modified internucleotide linkages and 2’ sugar modified nucleosides, such as 2‘-4‘ bicyclic ribose modified nucleosides, including LNA and cET or 2’ substituted modifications like of 2’-O-alkyl-RNA, 2’-O-methyl-RNA, 2’-alkoxy-RNA, 2’-O- methoxyethyl-RNA (MOE), 2’-amino-DNA, 2’-fluoro-DNA, arabino nucleic acid (ANA), 2’-fluoro- ANA.
  • 2’fluoro, 2’-O-methyl or 2’-O-methoxyethyl may be incorporated into siRNAs.
  • all of the nucleotides of an siRNA sense (passenger) strand may be modified with 2’ sugar modified nucleosides such as LNA (see W02004/083430, W02007/085485 for example).
  • the passenger stand of the siRNA may be discontinuous (see W02007/107162 for example).
  • the incorporation of thermally destabilizing nucleotides occurring at a seed region of the antisense strand of siRNAs have been reported as useful in reducing off-target activity of siRNAs (see WO2018/098328 for example).
  • the siRNA comprises a 5’ phosphate group or a 5’-phosphate mimic at the 5’ end of the antisense strand.
  • the 5’ end of the antisense strand is a RNA nucleoside.
  • the siRNA molecule further comprises at least one phosphorothioate or methylphosphonate internucleoside linkage.
  • the phosphorothi perennial or methylphosphonate internucleoside linkage may be at the 3'- terminus one or both strand (e.g., the antisense strand; or the sense strand); or the phosphorothioate or methylphosphonate internucleoside linkage may be at the 5'-terminus of one or both strands (e.g., the antisense strand; or the sense strand); or the phosphorothioate or methylphosphonate internucleoside linkage may be at the both the 5'- and 3'-terminus of one or both strands (e.g., the antisense strand; or the sense strand).
  • the remaining internucleoside linkages are phosphodiester linkages.
  • siRNA molecules comprise one or more phosphorothioate internucleoside linkages. In siRNA molecules phosphorothioate internucleoside linkages may reduce or the nuclease cleavage in RICS, it is therefore advantageous that not all internucleoside linkages in the antisense strand are modified.
  • the siRNA molecule may further comprise a ligand.
  • the ligand is conjugated to the 3' end of the sense strand.
  • siRNAs may be conjugated to a targeting ligand, and/or be formulated into lipid nanoparticles.
  • Other aspects of the invention relate to pharmaceutical compositions comprising these dsRNA, such as siRNA molecules suitable for therapeutic use, and methods of inhibiting the expression of the target gene by administering the dsRNA molecules such as siRNAs of the invention, e.g., for the treatment of various disease conditions as disclosed herein.
  • short hairpin RNA refers to molecules that are generally between 40 and 70 nucleotides in length, such as between 45 and 65 nucleotides in length, such as 50 and 60 nucleotides in length and form a stem loop (hairpin) RNA structure which interacts with the endonuclease known as Dicer which is believed to processes dsRNA into 19-23 base pair short interfering RNAs with characteristic two base 3' overhangs which are then incorporated into an RNA-induced silencing complex (RISC).
  • RISC RNA-induced silencing complex
  • shRNA oligonucleotides may be chemically modified using modified internucleotide linkages and 2’ sugar modified nucleosides, such as 2‘-4‘ bicyclic ribose modified nucleosides, including LNA and cET or 2’ substituted modifications like of 2’-O-alkyl-RNA, 2’-O-methyl-RNA, 2’-alkoxy-RNA, 2’-O-methoxyethyl-RNA (MOE), 2’-amino-DNA, 2’-fluoro-DNA, arabino nucleic acid (ANA), 2’- fluoro-ANA.
  • 2’-4‘ bicyclic ribose modified nucleosides including LNA and cET or 2’ substituted modifications like of 2’-O-alkyl-RNA, 2’-O-methyl-RNA, 2’-alkoxy-RNA, 2’-O-methoxyethyl-RNA (MOE), 2’-amino-DNA, 2’-fluoro-
  • shRNA molecule comprises one or more phosphorothioate internucleoside linkages.
  • phosphorothioate internucleoside linkages may reduce or the nuclease cleavage in RIOS it is therefore advantageous that not al internucleoside linkages in the stem loop of the shRNA molecule are modified.
  • Phosphorothioate internucleoside linkages can advantageously be placed in the 3’ and/or 5’ end of the stem loop of the shRNA molecule, in particular in the part of the molecule that is not complementary to the target nucleic acid.
  • the region of the shRNA molecule that is complementary to the target nucleic acid may however also be modified in the first 2 to 3 internucleoside linkages in the part that is predicted to become the 3’ and/or 5’ terminal following cleavage by Dicer.
  • contiguous nucleotide sequence refers to the region of the nucleic acid molecule which is complementary to the target nucleic acid.
  • the term is used interchangeably herein with the term “contiguous nucleobase sequence” and the term “oligonucleotide motif sequence”.
  • all the nucleotides of the oligonucleotide constitute the contiguous nucleotide sequence.
  • the contiguous nucleotide sequence is included in the guide strand of an siRNA molecule.
  • the contiguous nucleotide sequence is the part of an shRNA molecule which is 100% complementary to the target nucleic acid.
  • the oligonucleotide comprises the contiguous nucleotide sequence, such as a F-G-F’ gapmer region, and may optionally comprise further nucleotide(s), for example a nucleotide linker region which may be used to attach a functional group (e.g. a conjugate group for targeting) to the contiguous nucleotide sequence.
  • the nucleotide linker region may or may not be complementary to the target nucleic acid.
  • the nucleobase sequence of the antisense oligonucleotide is the contiguous nucleotide sequence.
  • the contiguous nucleotide sequence is 100% complementary to the target nucleic acid.
  • Nucleotides and nucleosides are the building blocks of oligonucleotides and polynucleotides, and for the purposes of the present invention include both naturally occurring and non-naturally occurring nucleotides and nucleosides.
  • nucleotides such as DNA and RNA nucleotides comprise a ribose sugar moiety, a nucleobase moiety and one or more phosphate groups (which is absent in nucleosides).
  • Nucleosides and nucleotides may also interchangeably be referred to as “units” or “monomers”.
  • modified nucleoside or “nucleoside modification” as used herein refers to nucleosides modified as compared to the equivalent DNA or RNA nucleoside by the introduction of one or more modifications of the sugar moiety or the (nucleo)base moiety.
  • one or more of the modified nucleoside comprises a modified sugar moiety.
  • modified nucleoside may also be used herein interchangeably with the term “nucleoside analogue” or modified “units” or modified “monomers”.
  • Nucleosides with an unmodified DNA or RNA sugar moiety are termed DNA or RNA nucleosides herein.
  • Nucleosides with modifications in the base region of the DNA or RNA nucleoside are still generally termed DNA or RNA if they allow Watson Crick base pairing.
  • modified internucleoside linkage is defined as generally understood by the skilled person as linkages other than phosphodiester (PO) linkages, that covalently couples two nucleosides together.
  • the oligonucleotides of the invention may therefore comprise one or more modified intemucleoside linkages, such as a one or more phosphorothioate internucleoside linkages, or one or more phosphorodithioate intemucleoside linkages.
  • oligonucleotide of the invention it is advantageous to use phosphorothioate intemucleoside linkages.
  • Phosphorothioate intemucleoside linkages are particularly useful due to nuclease resistance, beneficial pharmacokinetics and ease of manufacture.
  • at least 50% of the intemucleoside linkages in the oligonucleotide, or contiguous nucleotide sequence thereof are phosphorothioate, such as at least 60%, such as at least 70%, such as at least 75%, such as at least 80% or such as at least 90% of the intemucleoside linkages in the oligonucleotide, or contiguous nucleotide sequence thereof, are phosphorothioate.
  • all of the internucleoside linkages of the oligonucleotide, or contiguous nucleotide sequence thereof are phosphorothioate.
  • all the internucleoside linkages of the contiguous nucleotide sequence of the oligonucleotide are phosphorothioate, or all the internucleoside linkages of the oligonucleotide are phosphorothioate linkages.
  • antisense oligonucleotides may comprise other internucleoside linkages (other than phosphodiester and phosphorothioate), for example alkyl phosphonate/methyl phosphonate internucleoside linkages, which according to EP 2 742 135 may for example be tolerated in an otherwise DNA phosphorothioate gap region.
  • nucleobase includes the purine (e.g. adenine and guanine) and pyrimidine (e.g. uracil, thymine and cytosine) moiety present in nucleosides and nucleotides which form hydrogen bonds in nucleic acid hybridization.
  • pyrimidine e.g. uracil, thymine and cytosine
  • nucleobase also encompasses modified nucleobases which may differ from naturally occurring nucleobases, but are functional during nucleic acid hybridization.
  • nucleobase refers to both naturally occurring nucleobases such as adenine, guanine, cytosine, thymidine, uracil, xanthine and hypoxanthine, as well as non-naturally occurring variants. Such variants are for example described in Hirao et al (2012) Accounts of Chemical Research vol 45 page 2055 and Bergstrom (2009) Current Protocols in Nucleic Acid Chemistry Suppl. 37 1.4.1.
  • the nucleobase moiety is modified by changing the purine or pyrimidine into a modified purine or pyrimidine, such as substituted purine or substituted pyrimidine, such as a nucleobased selected from isocytosine, pseudoisocytosine, 5-methyl cytosine, 5-thiozolo- cytosine, 5-propynyl-cytosine, 5-propynyl-uracil, 5-bromouracil 5-thiazolo-uracil, 2-thio-uracil, 2’thio-thymine, inosine, diaminopurine, 6-aminopurine, 2-aminopurine, 2,6-diaminopurine and 2- chloro-6-aminopurine.
  • a nucleobased selected from isocytosine, pseudoisocytosine, 5-methyl cytosine, 5-thiozolo- cytosine, 5-propynyl-cytosine, 5-propynyl-uracil, 5-bro
  • the nucleobase moieties may be indicated by the letter code for each corresponding nucleobase, e.g. A, T, G, C or U, wherein each letter may optionally include modified nucleobases of equivalent function.
  • the nucleobase moieties are selected from A, T, G, C, and 5-methyl cytosine.
  • 5-methyl cytosine LNA nucleosides may be used.
  • modified oligonucleotide describes an oligonucleotide comprising one or more sugar- modified nucleosides and/or modified internucleoside linkages.
  • chimeric oligonucleotide is a term that has been used in the literature to describe oligonucleotides comprising modified nucleosides and DNA nucleosides.
  • the antisense oligonucleotide of the invention is advantageously a chimeric oligonucleotide. Complementarity
  • Watson-Crick base pairs are guanine (G)-cytosine (C) and adenine (A) - thymine (T)/uracil (U).
  • oligonucleotides may comprise nucleosides with modified nucleobases, for example 5-methyl cytosine is often used in place of cytosine, and as such the term complementarity encompasses Watson Crick base-paring between non-modified and modified nucleobases (see for example Hirao et al (2012) Accounts of Chemical Research vol 45 page 2055 and Bergstrom (2009) Current Protocols in Nucleic Acid Chemistry Suppl. 37 1.4.1).
  • % complementary refers to the proportion of nucleotides (in percent) of a contiguous nucleotide sequence in a nucleic acid molecule (e.g. oligonucleotide) which across the contiguous nucleotide sequence, are complementary to a reference sequence (e.g. a target sequence or sequence motif).
  • the percentage of complementarity is thus calculated by counting the number of aligned nucleobases that are complementary (from Watson Crick base pair) between the two sequences (when aligned with the target sequence 5’-3’ and the oligonucleotide sequence from 3’-5’), dividing that number by the total number of nucleotides in the oligonucleotide and multiplying by 100.
  • nucleobase/nucleotide which does not align is termed a mismatch. Insertions and deletions are not allowed in the calculation of % complementarity of a contiguous nucleotide sequence. It will be understood that in determining complementarity, chemical modifications of the nucleobases are disregarded as long as the functional capacity of the nucleobase to form Watson Crick base pairing is retained (e.g. 5’-methyl cytosine is considered identical to a cytosine for the purpose of calculating % identity).
  • Identity refers to the proportion of nucleotides (expressed in percent) of a contiguous nucleotide sequence in a nucleic acid molecule (e.g. oligonucleotide) which across the contiguous nucleotide sequence, are identical to a reference sequence (e.g. a sequence motif).
  • the percentage of identity is thus calculated by counting the number of aligned nucleobases that are identical (a Match) between two sequences (in the contiguous nucleotide sequence of the compound of the invention and in the reference sequence), dividing that number by the total number of nucleotides in the oligonucleotide and multiplying by 100.
  • Percentage of Identity (Matches x 100)/Length of aligned region (e.g. the contiguous nucleotide sequence). Insertions and deletions are not allowed in the calculation the percentage of identity of a contiguous nucleotide sequence. It will be understood that in determining identity, chemical modifications of the nucleobases are disregarded as long as the functional capacity of the nucleobase to form Watson Crick base pairing is retained (e.g. 5- methyl cytosine is considered identical to a cytosine for the purpose of calculating % identity).
  • hybridizing or “hybridizes” as used herein is to be understood as two nucleic acid strands (e.g. an oligonucleotide and a target nucleic acid) forming hydrogen bonds between base pairs on opposite strands thereby forming a duplex.
  • the affinity of the binding between two nucleic acid strands is the strength of the hybridization. It is often described in terms of the melting temperature (T m ) defined as the temperature at which half of the oligonucleotides are duplexed with the target nucleic acid. At physiological conditions T m is not strictly proportional to the affinity (Mergny and Lacroix, 2003, Oligonucleotides 13:515-537).
  • AG° is the energy associated with a reaction where aqueous concentrations are 1 M, the pH is 7, and the temperature is 37°C.
  • the hybridization of oligonucleotides to a target nucleic acid is a spontaneous reaction and for spontaneous reactions AG° is less than zero.
  • AG° can be measured experimentally, for example, by use of the isothermal titration calorimetry (ITC) method as described in Hansen et al., 1965, C em. Comm. 36-38 and Holdgate et al., 2005, Drug Discov Today. The skilled person will know that commercial equipment is available for AG° measurements. AG° can also be estimated numerically by using the nearest neighbor model as described by SantaLucia, 1998, Proc Natl Acad Sci USA. 95: 1460-1465 using appropriately derived thermodynamic parameters described by Sugimoto et al., 1995, Biochemistry 34:11211-11216 and McTigue et al., 2004, Biochemistry 43:5388-5405.
  • ITC isothermal titration calorimetry
  • oligonucleotides of the present invention hybridize to a target nucleic acid with estimated AG° values below -10 kcal for oligonucleotides that are 10 to 30 nucleotides in length.
  • the degree or strength of hybridization is measured by the standard state Gibbs free energy AG°.
  • the oligonucleotides may hybridize to a target nucleic acid with estimated AG° values below -10 kcal, such as below -15 kcal, such as below -20 kcal and such as below -25 kcal for oligonucleotides that are 8 to 30 nucleotides in length.
  • the oligonucleotides hybridize to a target nucleic acid with an estimated AG° value in the range of of -10 to -60 kcal, such as -12 to -40, such as from -15 to - 30 kcal or-16 to -27 kcal such as -18 to -25 kcal.
  • the target nucleic acid is a nucleic acid which encodes mammalian A1CF and may for example be a gene, a RNA, a mRNA, and pre-mRNA, a mature mRNA or a cDNA sequence.
  • the target may therefore be referred to as A1 CF target nucleic acid.
  • the target nucleic acid encodes an A1CF protein, in particular mammalian A1CF, such as the human A1CF gene encoding pre-mRNA or mRNA sequences provided herein as SEQ ID NO: 1, 4, 5, 6, 7, 8, 9, 10, or 11.
  • A1CF protein in particular mammalian A1CF, such as the human A1CF gene encoding pre-mRNA or mRNA sequences provided herein as SEQ ID NO: 1, 4, 5, 6, 7, 8, 9, 10, or 11.
  • the therapeutic oligonucleotides of the invention may for example target exon regions of a mammalian A1CF (in particular siRNA and shRNA, but also antisense oligonucleotides), or may for example target any intron region in the A1CF pre-mRNA (in particular antisense oligonucleotides).
  • A1CF mammalian A1CF
  • shRNA shRNA
  • antisense oligonucleotides may for example target any intron region in the A1CF pre-mRNA (in particular antisense oligonucleotides).
  • the human A1CF gene encodes 10 transcript, eight of which are protein coding and therefore potential nucleic acid targets.
  • Table 1 lists predicted exon and intron regions of SEQ ID NO: 1, i.e. of the human A1CF pre- mRNA sequence.
  • the target nucleic acid encodes an A1CF protein, in particular mammalian A1CF, such as human A1CF (See for example Table 2 and Table 3) which provides an overview on the genomic sequences of human, cyno monkey and mouse A1CF (Table 2) and on pre-mRNA sequences for human, monkey and mouse A1CF and for the mature mRNAs for human A1CF (Table 3).
  • the target nucleic acid is selected from the group consisting of SEQ ID NO: 1, 2, 3, 4, 6, 7, 8, 10, and 11, or naturally occurring variants thereof (e.g. sequences encoding a mammalian A1CF).
  • Fwd forward strand.
  • Rv reverse strand.
  • the genome coordinates provide the pre-mRNA sequence (genomic sequence).
  • the target nucleic acid may be a cDNA or a synthetic nucleic acid derived from DNA or RNA.
  • the therapeutic nucleic acid molecule of the invention is typically capable of inhibiting the expression of the A1 OF target nucleic acid in a cell which is expressing the A1CF target nucleic acid.
  • said cell comprises HBV cccDNA.
  • the contiguous sequence of nucleobases of the nucleic acid molecule of the invention is typically complementary to a conserved region of the A1CF target nucleic acid, as measured across the length of the nucleic acid molecule, optionally with the exception of one or two mismatches, and optionally excluding nucleotide based linker regions which may link the oligonucleotide to an optional functional group such as a conjugate, or other non- complementary terminal nucleotides.
  • the target nucleic acid is a messenger RNA, such as a pre-mRNA which encodes mammalian A1CF protein, such as human A1CF, e.g.
  • the human A1CF pre-mRNA sequence such as that disclosed as SEQ ID NO: 1
  • the monkey A1CF pre- mRNA sequence such as that disclosed as SEQ ID NO: 2
  • the mouse A1CF pre-mRNA sequence such as that disclosed as SEQ ID NO: 3
  • a mature A1CF mRNA such as that a human mature mRNA disclosed as SEQ ID NO: 4, 6, 7, 8, 10, or 11.
  • SEQ ID NOs: 1 - 13 are DNA sequences - it will be understood that target RNA sequences have uracil (U) bases in place of the thymidine bases (T).
  • the target nucleic acid is SEQ ID NO: 1. In some embodiments, the target nucleic acid is SEQ ID NO: 2. In some embodiments, the target nucleic acid is SEQ ID NO: 3. In some embodiments, the target nucleic acid is SEQ ID NO: 4. In some embodiments, the target nucleic acid is SEQ ID NO: 5. In some embodiments, the target nucleic acid is SEQ ID NO: 6. In some embodiments, the target nucleic acid is SEQ ID NO: 7. In some embodiments, the target nucleic acid is SEQ ID NO: 8. In some embodiments, the target nucleic acid is SEQ ID NO: 9. In some embodiments, the target nucleic acid is SEQ ID NO: 10. In some embodiments, the target nucleic acid is SEQ ID NO: 11.
  • target sequence refers to a sequence of nucleotides present in the target nucleic acid which comprises the nucleobase sequence which is complementary to the oligonucleotide or nucleic acid molecule of the invention.
  • the target sequence consists of a region on the target nucleic acid with a nucleobase sequence that is complementary to the contiguous nucleotide sequence of the oligonucleotide of the invention. This region of the target nucleic acid may interchangeably be referred to as the target nucleotide sequence, target sequence or target region.
  • the target sequence is longer than the complementary sequence of a nucleic acid molecule of the invention, and may, for example represent a preferred region of the target nucleic acid which may be targeted by several nucleic acid molecules of the invention.
  • the target sequence is a sequence selected from the group consisting of a human A1CF mRNA exon, such as an A1CF human mRNA exon selected from the group consisting of e1, e2, e3, e4, e5, e6, e7, e8, e9, e10, e11, e12, 13, e14, and e15, (see for example Table 1 above).
  • the invention provides for an oligonucleotide, wherein said oligonucleotide comprises a contiguous sequence which is at least 90% complementary, such as fully complementary to an exon region of SEQ ID NO: 1 , selected from the group consisting of e1 - e15 (see Table 1).
  • the target sequence is a sequence selected from the group consisting of a human AICFmRNA intron, such as an A1CF human mRNA intron selected from the group consisting of i1 , i2, i3, i4, i5, i6, i7, i8, i9, i10, i11 , i12, i13, and i14 (see for example Table 1 above).
  • a human AICFmRNA intron such as an A1CF human mRNA intron selected from the group consisting of i1 , i2, i3, i4, i5, i6, i7, i8, i9, i10, i11 , i12, i13, and i14 (see for example Table 1 above).
  • the invention provides for an oligonucleotide, wherein said oligonucleotide comprises a contiguous sequence which is at least 90% complementary, such as fully complementary to an intron region of SEQ ID NO: 1 , selected from the group consisting of i1 - i14 (see Table 1).
  • the target sequence is selected from the group consisting of SEQ ID NO: 12, 13, 14 and 15.
  • the contiguous nucleotide sequence as referred to herein is at least 90% complementary, such as at least 95% complementary to a target sequence selected from the group consisting of SEQ ID NO: 12, 13, 14 and 15.
  • the contiguous nucleotide sequence is fully complementary to a target sequence selected from the group consisting of SEQ ID NO: 12, 13, 14 and 15.
  • the oligonucleotide of the invention comprises a contiguous nucleotide sequence which is complementary to or hybridizes to a region on the target nucleic acid, such as a target sequence described herein.
  • the target nucleic acid sequence to which the therapeutic oligonucleotideis complementary or hybridizes to generally comprises a stretch of contiguous nucleobases of at least 10 nucleotides.
  • the contiguous nucleotide sequence is between 12 to 70 nucleotides, such as 12 to 50, such as 13 to 30, such as 14 to 25, such as 15 to 20, such as 16 to 18 contiguous nucleotides.
  • the oligonucleotideof the present invention targets a region shown in Table 4 or 5.
  • the target sequence is selected from the group consisting of target regions 1A to 2001A as shown in Table 4 above.
  • the target sequence is selected from the group consisting of target regions 1C to 178C as shown in Table 5 above.
  • a “target cell” as used herein refers to a cell which is expressing the target nucleic acid.
  • the target cell may be in vivo or in vitro.
  • the target cell is a mammalian cell such as a rodent cell, such as a mouse cell or a rat cell, or a woodchuck cell or a primate cell such as a monkey cell (e.g. a cynomolgus monkey cell) or a human cell.
  • the target cell expresses A1CF mRNA, such as the A1CF pre-mRNA or A1 CF mature mRNA.
  • A1CF mRNA such as the A1CF pre-mRNA or A1 CF mature mRNA.
  • the poly A tail of A1 CF mRNA is typically disregarded for antisense oligonucleotide targeting.
  • the target cell may be a hepatocyte.
  • the target cell is HBV infected primary human hepatocytes, either derived from HBV infected individuals or from a HBV infected mouse with a humanized liver (PhoenixBio, PXB-mouse).
  • the target cell may be infected with HBV. Further, the target cell may comprise HBV cccDNA.
  • the target cell preferably comprises A1CF mRNA, such as the A1CF pre-mRNA or A1CF mature mRNA, and HBV cccDNA.
  • the target cell is a human cell. In one embodiment, the human cell is a hepatocyte.
  • naturally occurring variant refers to variants of A1CF gene or transcripts which originate from the same genetic loci as the target nucleic acid, but may differ for example, by virtue of degeneracy of the genetic code causing a multiplicity of codons encoding the same amino acid, or due to alternative splicing of pre-mRNA, or the presence of polymorphisms, such as single nucleotide polymorphisms (SNPs), and allelic variants. Based on the presence of the sufficient complementary sequence to the oligonucleotide, the oligonucleotide of the invention may therefore target the target nucleic acid and naturally occurring variants thereof.
  • SNPs single nucleotide polymorphisms
  • the naturally occurring variants have at least 95% such as at least 98% or at least 99% homology to a mammalian A1CF target nucleic acid, such as a target nucleic acid of SEQ ID NO: 1 and/or SEQ ID NO: 2. In some embodiments, the naturally occurring variants have at least 99% homology to the human A1CF target nucleic acid of SEQ ID NO: 1. In some embodiments, the naturally occurring variants are known polymorphisms.
  • inhibitors as used herein is to be understood as an overall term for an A1CF (APOBEC1 complementation factor) inhibitors ability to inhibit amount or the activity of A1CF in a target cell. Inhibition of expression or activity may be determined by measuring the level of A1CF pre-mRNA or A1CF mRNA, or by measuring the level of A1CF protein or activity in a cell. Inhibition of expression may be determined in vitro or in vivo. Inhibition is determined by reference to a control. It is generally understood that the control is an individual or target cell treated with a saline composition.
  • inhibitor may also be referred to as down-regulate, reduce, suppress, lessen, lower, decrease the expression or activity of A1CF.
  • the inhibition of expression of A1 CF may occur e.g. by degradation of pre-mRNA or mRNA e.g. using RNase H recruiting oligonucleotides, such as gapmers, or nucleic acid molecules that function via the RNA interference pathway, such as siRNA or shRNA.
  • the inhibitor of the present invention may bind to A1CF polypeptide and inhibit the activity of A1CF or prevent its binding to other molecules.
  • the inhibition of expression of the A1CF target nucleic acid or the activity of A1CF protein results in a decreased amount of HBV cccDNA in the target cell.
  • the amount of HBV cccDNA is decreased as compared to a control.
  • the decrease in amount of HBV cccDNA is at least 20%, at least 30%, as compared to a control.
  • the amount of cccDNA in an HBV infected cell is reduced by at least 50%, such as 60%, such as 70%, when compared to a control.
  • the inhibition of expression of the A1CF target nucleic acid or the activity of A1CF protein results in a decreased amount of HBV pgRNA in the target cell.
  • the amount of HBV pgRNA is decreased as compared to a control.
  • the decrease in amount of HBV pgRNA is at least 20%, at least 30%, as compared to a control.
  • the amount of pgRNA in an HBV infected cell is reduced by at least 50%, such as 60%, when compared to a control.
  • the oligonucleotide of the invention may comprise one or more nucleosides which have a modified sugar moiety, i.e. a modification of the sugar moiety when compared to the ribose sugar moiety found in DNA and RNA.
  • nucleosides with modification of the ribose sugar moiety have been made, primarily with the aim of improving certain properties of oligonucleotides, such as affinity and/or nuclease resistance.
  • Such modifications include those where the ribose ring structure is modified, e.g. by replacement with a hexose ring (HNA), or a bicyclic ring, which typically have a biradical bridge between the C2 and C4 carbons on the ribose ring (LNA), or an unlinked ribose ring which typically lacks a bond between the C2 and C3 carbons (e.g. UNA).
  • HNA hexose ring
  • LNA ribose ring
  • UNA unlinked ribose ring which typically lacks a bond between the C2 and C3 carbons
  • Other sugar modified nucleosides include, for example, bicyclohexose nucleic acids (WO2011/017521) or tricyclic nucleic acids (WO2013/154798). Modified nucleosides also include nucleosides where the sugar moiety is replaced with a non-sugar moiety, for example in the case of
  • Sugar modifications also include modifications made via altering the substituent groups on the ribose ring to groups other than hydrogen, or the 2’-OH group naturally found in DNA and RNA nucleosides. Substituents may, for example be introduced at the 2’, 3’, 4’ or 5’ positions.
  • a high affinity modified nucleoside is a modified nucleotide which, when incorporated into the oligonucleotide enhances the affinity of the oligonucleotide for its complementary target, for example as measured by the melting temperature (T m ).
  • a high affinity modified nucleoside of the present invention preferably result in an increase in melting temperature in the range of +0.5 to +12°C, more preferably in the range of +1.5 to +10°C and most preferably in the range of +3 to +8°C per modified nucleoside.
  • Numerous high affinity modified nucleosides are known in the art and include for example, many 2’ substituted nucleosides as well as locked nucleic acids (LNA) (see e.g. Freier & Altmann; Nucl. Acid Res., 1997, 25, 4429-4443 and Uhlmann; Curr. Opinion in Drug Development, 2000, 3(2), 293-213).
  • a 2’ sugar modified nucleoside is a nucleoside which has a substituent other than H or -OH at the 2’ position (2’ substituted nucleoside) or comprises a 2’ linked biradical capable of forming a bridge between the 2’ carbon and a second carbon in the ribose ring, such as LNA (2’ - 4’ biradical bridged) nucleosides.
  • the 2’ modified sugar may provide enhanced binding affinity and/or increased nuclease resistance to the oligonucleotide.
  • 2’ substituted modified nucleosides are 2’-O-alkyl-RNA, 2’-O-methyl-RNA, 2’-alkoxy-RNA, 2’-O- methoxyethyl-RNA (MOE), 2’-amino-DNA, 2’-Fluoro-RNA, and 2’-F-ANA nucleoside.
  • MOE methoxyethyl-RNA
  • substituted sugar modified nucleosides does not include 2’ bridged nucleosides like LNA.
  • LNA nucleosides Locked Nucleic Acid Nucleosides
  • a “LNA nucleoside” is a 2’-sugar modified nucleoside which comprises a biradical linking the C2’ and C4’ of the ribose sugar ring of said nucleoside (also referred to as a “2’- 4’ bridge”), which restricts or locks the conformation of the ribose ring.
  • These nucleosides are also termed bridged nucleic acid or bicyclic nucleic acid (BNA) in the literature. The locking of the conformation of the ribose is associated with an enhanced affinity of hybridization (duplex stabilization) when the LNA is incorporated into an oligonucleotide for a complementary RNA or DNA molecule.
  • Non limiting, exemplary LNA nucleosides are disclosed in WO 99/014226, WO 00/66604, WO 98/039352, WO 2004/046160, WO 00/047599, WO 2007/134181, WO 2010/077578, WO 2010/036698, WO 2007/090071 , WO 2009/006478, WO 2011/156202, WO 2008/154401 , WO 2009/067647, WO 2008/150729, Morita et al., Bioorganic & Med.Chem. Lett. 12, 73-76, Seth et al. J. Org.
  • LNA nucleosides are beta-D-oxy-LNA, 6’-methyl-beta-D-oxy LNA such as (S)-6’- methyl-beta-D-oxy-LNA (ScET) and ENA.
  • ScET methyl-beta-D-oxy-LNA
  • ENA ENA
  • the RNase H activity of an antisense oligonucleotide refers to its ability to recruit RNase H when in a duplex with a complementary RNA molecule.
  • WO01/23613 provides in vitro methods for determining RNase H activity, which may be used to determine the ability to recruit RNase H.
  • an oligonucleotide is deemed capable of recruiting RNase H if it, when provided with a complementary target nucleic acid sequence, has an initial rate, as measured in pmol/l/min, of at least 5%, such as at least 10% or more than 20% of the of the initial rate determined when using a oligonucleotide having the same base sequence as the modified oligonucleotide being tested, but containing only DNA monomers with phosphorothioate linkages between all monomers in the oligonucleotide, and using the methodology provided by Example 91 - 95 of WO 01/23613 (hereby incorporated by reference).
  • recombinant human RNase H1 is available from Creative Biomart® (Recombinant Human RNase H1 fused with His tag expressed in E. coli)..
  • the antisense oligonucleotide of the invention may be a gapmer, also termed gapmer oligonucleotide or gapmer designs.
  • the antisense gapmers are commonly used to inhibit a target nucleic acid via RNase H mediated degradation.
  • a gapmer oligonucleotide comprises at least three distinct structural regions a 5’-flank, a gap and a 3’-flank, F-G-F’ in the ‘5 -> 3’ orientation.
  • the “gap” region (G) comprises a stretch of contiguous DNA nucleotides which enable the oligonucleotide to recruit RNase H.
  • the gap region is flanked by a 5’ flanking region (F) comprising one or more sugar modified nucleosides, advantageously high affinity sugar modified nucleosides, and by a 3’ flanking region (F’) comprising one or more sugar modified nucleosides, advantageously high affinity sugar modified nucleosides.
  • the one or more sugar modified nucleosides in region F and F’ enhance the affinity of the oligonucleotide for the target nucleic acid (J.e. are affinity enhancing sugar modified nucleosides).
  • the one or more sugar modified nucleosides in region F and F’ are 2’ sugar modified nucleosides, such as high affinity 2’ sugar modifications, such as independently selected from LNA and 2’-MOE.
  • the 5’ and 3’ most nucleosides of the gap region are DNA nucleosides, and are positioned adjacent to a sugar modified nucleoside of the 5’ (F) or 3’ (F’) region respectively.
  • the flanks may further be defined by having at least one sugar modified nucleoside at the end most distant from the gap region, i.e. at the 5’ end of the 5’ flank and at the 3’ end of the 3’ flank.
  • Regions F-G-F’ form a contiguous nucleotide sequence.
  • Antisense oligonucleotides of the invention, or the contiguous nucleotide sequence thereof, may comprise a gapmer region of formula F-G-F’.
  • the overall length of the gapmer design F-G-F’ may be, for example 12 to 32 nucleosides, such as 13 to 24, such as 14 to 22 nucleosides, such as from 15 to 20, such as 16 to 18 nucleosides.
  • the gapmer oligonucleotide of the present invention can be represented by the following formulae:
  • Fi-g-Gs-ig-F’i-g such as
  • the antisense oligonucleotide or contiguous nucleotide sequence thereof consists of or comprises a gapmer of formula 5’-F-G-F’-3’, where region F and F’ independently comprise or consist of 1-8 nucleosides, of which 1-4 are 2’ sugar modified and defines the 5’ and 3’ end of the F and F’ region, and G is a region between 6 and 18 nucleosides which are capable of recruiting RNase H.
  • the G region consists of DNA nucleosides.
  • region F and F’ independently consists of or comprises a contiguous sequence of sugar modified nucleosides.
  • the sugar modified nucleosides of region F may be independently selected from 2’-O-alkyl-RNA units, 2’-O-methyl- RNA, 2’-amino-DNA units, 2’-fluoro-DNA units, 2’-alkoxy-RNA, MOE units, LNA units, arabino nucleic acid (ANA) units and 2’-fluoro-ANA units.
  • region F and F’ independently comprises both LNA and a 2’-substituted sugar modified nucleotide (mixed wing design).
  • the 2’-substituted sugar modified nucleotide is independently selected from the group consisting of 2’-O-alkyl-RNA units, 2’-O-methyl-RNA, 2’-amino-DNA units, 2’-fluoro-DNA units, 2’-alkoxy-RNA, MOE units, arabino nucleic acid (ANA) units and 2’-fluoro-ANA units.
  • all the modified nucleosides of region F and F’ are LNA nucleosides, such as independently selected from beta-D-oxy LNA, ENA or ScET nucleosides, wherein region F or F’, or F and F’ may optionally comprise DNA nucleosides.
  • all the modified nucleosides of region F and F’ are beta-D-oxy LNA nucleosides, wherein region F or F’, or F and F’ may optionally comprise DNA nucleosides.
  • the flanking region F or F’, or both F and F’ comprise at least three nucleosides, wherein the 5’ and 3’ most nucleosides of the F and/or F’ region are LNA nucleosides.
  • An LNA gapmer is a gapmer wherein either one or both of region F and F’ comprises or consists of LNA nucleosides.
  • a beta-D-oxy gapmer is a gapmer wherein either one or both of region F and F’ comprises or consists of beta-D-oxy LNA nucleosides.
  • the LNA gapmer is of formula: [LNA]i-5-[region G] 8 -IS -[LNA]I-5, wherein region G is as defined in the Gapmer region G definition.
  • a MOE gapmers is a gapmer wherein regions F and F’ consist of MOE nucleosides.
  • the MOE gapmer is of design [MOE]i. 8 -[Region G] 5 -i6-[MOE] i- 8 , such as [MOE] 2 . 7-[Region G]e-14-[MOE] 2-7 > such as [MOE] 3-6 -[Region G] 8 -I 2 -[MOE] 3-6 , such as [MOE] 5 -[Region G]io-[MOE] 5 wherein region G is as defined in the Gapmer definition.
  • MOE gapmers with a 5- 10-5 design have been widely used in the art.
  • the oligonucleotide of the invention may in some embodiments comprise or consist of the contiguous nucleotide sequence of the oligonucleotide which is complementary to the target nucleic acid, such as a gapmer region F-G-F’, and further 5’ and/or 3’ nucleosides.
  • the further 5’ and/or 3’ nucleosides may or may not be fully complementary to the target nucleic acid.
  • Such further 5’ and/or 3’ nucleosides may be referred to as region D’ and D” herein.
  • region D’ or D may be used for the purpose of joining the contiguous nucleotide sequence, such as the gapmer, to a conjugate moiety or another functional group.
  • region D may be used for joining the contiguous nucleotide sequence with a conjugate moiety.
  • a conjugate moiety is can serve as a biocleavable linker. Alternatively, it may be used to provide exonucleoase protection or for ease of synthesis or manufacture.
  • Region D’ and D can be attached to the 5’ end of region F or the 3’ end of region F’, respectively to generate designs of the following formulas D’-F-G-F’, F-G-F’-D” or D’-F-G-F’-D”.
  • the F-G-F’ is the gapmer portion of the oligonucleotide and region D’ or D” constitute a separate part of the oligonucleotide.
  • Region D’ or D may independently comprise or consist of 1 , 2, 3, 4 or 5 additional nucleotides, which may be complementary or non-complementary to the target nucleic acid.
  • the nucleotide adjacent to the F or F’ region is not a sugar-modified nucleotide, such as a DNA or RNA or base modified versions of these.
  • the D’ or D” region may serve as a nuclease susceptible biocleavable linker (see definition of linkers).
  • the additional 5’ and/or 3’ end nucleotides are linked with phosphodiester linkages, and are DNA or RNA.
  • Nucleotide based biocleavable linkers suitable for use as region D’ or D are disclosed in WO2014/076195, which include by way of example a phosphodiester linked DNA dinucleotide.
  • the use of biocleavable linkers in poly-oligonucleotide constructs is disclosed in WO2015/113922, where they are used to link multiple antisense constructs (e.g. gapmer regions) within a single oligonucleotide.
  • the oligonucleotide of the invention comprises a region D’ and/or D” in addition to the contiguous nucleotide sequence which constitutes the gapmer.
  • the oligonucleotide of the present invention can be represented by the following formulae:
  • F-G-F in particular F1-8-G5-18-F 2-8
  • D’-F-G-F’ in particular D’i- 3 -Fi. 8 -G5-i8-F’2-8
  • D’-F-G-F’-D in particular D’I- 3 - Fi- 8 -G5-i8-F’2-s-D”i- 3
  • the internucleoside linkage positioned between region D’ and region F is a phosphodiester linkage. In some embodiments, the internucleoside linkage positioned between region F’ and region D” is a phosphodiester linkage.
  • conjugate refers to an oligonucleotide which is covalently linked to a non-nucleotide moiety (conjugate moiety or region C or third region).
  • conjugate moiety may be covalently linked to the antisense oligonucleotide, optionally via a linker group, such as region D’ or D".
  • Oligonucleotide conjugates and their synthesis have been reported in comprehensive reviews by Manoharan in Antisense Drug Technology, Principles, Strategies, and Applications, S.T.
  • the non-nucleotide moiety is selected from the group consisting of carbohydrates (e.g. galactose or N-acetylgalactosamine (GalNAc)), cell surface receptor ligands, drug substances, hormones, lipophilic substances, polymers, proteins (e.g. antibodies), peptides, toxins (e.g. bacterial toxins), vitamins, viral proteins (e.g. capsids) or combinations thereof.
  • carbohydrates e.g. galactose or N-acetylgalactosamine (GalNAc)
  • cell surface receptor ligands e.g. antibodies
  • peptides e.g. bacterial toxins
  • vitamins e.g. capsids
  • conjugate moieties are those capable of binding to the asialoglycoprotein receptor (ASGPR).
  • ASGPR asialoglycoprotein receptor
  • tri-valent N-acetylgalactosamine conjugate moieties are suitable for binding to the ASGPR, see for example WO 2014/076196, WO 2014/207232 and WO 2014/179620 (hereby incorporated by reference).
  • Such conjugates serve to enhance uptake of the oligonucleotide to the liver.
  • a linkage or linker is a connection between two atoms that links one chemical group or segment of interest to another chemical group or segment of interest via one or more covalent bonds.
  • Conjugate moieties can be attached to the oligonucleotide directly or through a linking moiety (e.g. linker or tether).
  • Linkers serve to covalently connect a third region, e.g. a conjugate moiety (region C), to a first region, e.g. an oligonucleotide or contiguous nucleotide sequence complementary to the target nucleic acid (region A).
  • the conjugate or oligonucleotide conjugate of the invention may optionally, comprise a linker region (second region or region B and/or region Y) which is positioned between the oligonucleotide or contiguous nucleotide sequence complementary to the target nucleic acid (region A or first region) and the conjugate moiety (region C or third region).
  • a linker region second region or region B and/or region Y
  • Region B refers to biocleavable linkers comprising or consisting of a physiologically labile bond that is cleavable under conditions normally encountered or analogous to those encountered within a mammalian body.
  • Conditions under which physiologically labile linkers undergo chemical transformation include chemical conditions such as pH, temperature, oxidative or reductive conditions or agents, and salt concentration found in or analogous to those encountered in mammalian cells.
  • Mammalian intracellular conditions also include the presence of enzymatic activity normally present in a mammalian cell such as from proteolytic enzymes or hydrolytic enzymes or nucleases.
  • the biocleavable linker is susceptible to S1 nuclease cleavage.
  • the nuclease susceptible linker comprises between 1 and 5 nucleosides, such as 1 , 2, 3, 4 or 5 nucleosides, more preferably between 2 and 4 nucleosides and most preferably 2 or 3 linked nucleosides comprising at least two consecutive phosphodiester linkages, such as at least 3 or 4 or 5 consecutive phosphodiester linkages.
  • the nucleosides are DNA or RNA.
  • Phosphodiester containing biocleavable linkers are described in more detail in WO 2014/076195 (hereby incorporated by reference).
  • Region Y refers to linkers that are not necessarily biocleavable but primarily serve to covalently connect a conjugate moiety (region C or third region), to an oligonucleotide (region A or first region).
  • the region Y linkers may comprise a chain structure or an oligomer of repeating units such as ethylene glycol, amino acid units or amino alkyl groups
  • the oligonucleotide conjugates of the present invention can be constructed of the following regional elements A-C, A-B-C, A-B- Y-C, A-Y-B-C or A-Y-C.
  • the linker (region Y) is an amino alkyl, such as a C2 - C36 amino alkyl group, including, for example C6 to C12 amino alkyl groups, some embodiments the linker (region Y) is a C6 amino alkyl group.
  • treatment refers to both treatment of an existing disease (e.g. a disease or disorder as herein referred to), or prevention of a disease, i.e. prophylaxis. It will therefore be recognized that treatment as referred to herein may, in some embodiments, be prophylactic.
  • Prophylactic can be understood as preventing an HBV infection from turning into a chronic HBV infection or the prevention of severe liver diseases such as liver cirrhosis and hepatocellular carcinoma caused by a chronic HBV infection.
  • the “subject” may be a vertebrate.
  • the term “subject” includes both humans and other animals, particularly mammals, and other organisms.
  • the herein provided means and methods are applicable to both human therapy and veterinary applications.
  • the subject is a mammal. More preferably the subject is human.
  • the patient to be treated may suffers from HBV infection, such as chronic HBV infection.
  • HBV infection may suffer from hepatocellular carcinoma (HCC).
  • HCC hepatocellular carcinoma
  • the patient suffering from HBV infection does not suffer from hepatocellular carcinoma.
  • HBV cccDNA in infected hepatocytes is responsible for persistent chronic infection and reactivation, being the template for all viral subgenomic transcripts and pre-genomic RNA (pgRNA) to ensure both newly synthesized viral progeny and cccDNA pool replenishment via intracellular nucleocapsid recycling.
  • pgRNA pre-genomic RNA
  • A1 CF is associated with cccDNA stability. This knowledge allows for the opportunity to destabilize cccDNA in HBV infected subjects which in turn opens the opportunity for a complete cure of chronically infected HBV patients.
  • One aspect of the present invention is an A1 CF inhibitor for use in the treatment and/or prevention of Hepatitis B virus (HBV) infection, in particular a chronic HBV infection.
  • HBV Hepatitis B virus
  • the A1CF inhibitor can for example be a small molecule that specifically binds to A1CF protein, wherein said inhibitor prevents or reduces binding of A1CF protein to cccDNA.
  • An embodiment of the invention is an A1CF inhibitor which is capable of reducing the amount of cccDNA and/or pgRNA in an infected cell, such as an HBV infected cell.
  • the A1CF inhibitor is capable of reducing HBsAg and/or HBeAg in vivo in an HBV infected individual.
  • A1CF inhibitors for use in treatment of HBV are A1CF inhibitors for use in treatment of HBV
  • A1CF is involved in the stabilization of the cccDNA in the cell nucleus, either via direct or indirect binding to the cccDNA, and by preventing the binding/association of A1CF with cccDNA, the cccDNA is destabilized and becomes prone to degradation.
  • One embodiment of the invention is therefore an A1CF inhibitor which interacts with the A1CF protein, and prevents or reduces its binding/association to cccDNA.
  • the inhibitor is an antibody, antibody fragment or a small molecule compound.
  • the inhibitor may be an antibody, antibody fragment or a small molecule that specifically binds to the A1CF protein, such as the A1CF protein encoded by SEQ ID NO: 1 , 4, 5, 6, 7, 8, 9, 10 or 11.
  • Therapeutic nucleic acid molecules are potentially excellent A1CF inhibitors since they can target the A1 CF transcript and promote its degradation either via the RNA interference pathway or via RNase H cleavage.
  • oligonucleotides such as aptamers can also act as inhibitors of A1CF protein interactions.
  • One aspect of the present invention is an A1CF targeting nucleic acid molecule for use in treatment and/or prevention of Hepatitis B virus (HBV) infection.
  • a nucleic acid molecule can be selected from the group consisting of a single stranded antisense oligonucleotide, an siRNA, and a shRNA.
  • the present section describes novel nucleic acid molecules suitable for use in treatment and/or prevention of Hepatitis B virus (HBV) infection.
  • HBV Hepatitis B virus
  • the nucleic acid molecules of the present invention are capable of inhibiting expression of A1CF mRNA and/or protein in vitro and in vivo. The inhibition is achieved by hybridizing an oligonucleotide to a target nucleic acid encoding A1CF.
  • the target nucleic acid may be a mammalian A1CF sequence.
  • the target nucleic acid may be a human A1CF pre-mRNA sequence such as the sequence of SEQ ID NO: 1 or a human mature A1CF mRNA sequence selected from SEQ ID NO: 4 to 11 .
  • the target nucleic acid may be a cynomolgus monkey A1CF sequence such as the sequence of SEQ ID NO: 2.
  • the nucleic acid molecule of the invention is capable of modulating the expression of the target by inhibiting or down-regulating it. Preferably, such modulation produces an inhibition of expression of at least 20% compared to the normal expression level of the target, more preferably at least 30%, at least 40%, or at least 50%, inhibition compared to the normal expression level of the target.
  • the nucleic acid molecule of the invention may be capable of inhibiting expression levels of A1CF mRNA by at least 50% or 60% in vitro by transfecting 25 nM nucleic acid molecule into PXB-PHH cells, this range of target reduction is advantageous in terms of selecting nucleic acid molecules with good correlation to the cccDNA reduction.
  • the examples provide assays which may be used to measure A1CF mRNA inhibition (e.g. example 1 and the “Materials and Methods” section).
  • A1CF inhibition is triggered by the hybridization between a contiguous nucleotide sequence of the oligonucleotide, such as the guide strand of a siRNA or gapmer region of an antisense oligonucleotide, and the target nucleic acid.
  • the nucleic acid molecule of the invention comprises mismatches between the oligonucleotide and the target nucleic acid. Despite mismatches hybridization to the target nucleic acid may still be sufficient to show a desired inhibition of A1CF expression.
  • Reduced binding affinity resulting from mismatches may advantageously be compensated by increased number of nucleotides in the oligonucleotide complementary to the target nucleic acid and/or an increased number of modified nucleosides capable of increasing the binding affinity to the target, such as 2’ sugar modified nucleosides, including LNA, present within the oligonucleotide sequence.
  • An aspect of the present invention relates to a nucleic acid molecule of 12 to 60 nucleotides in length, which comprises a contiguous nucleotide sequence of at least 12 nucleotides in length, such as at least 12 to 30 nucleotides in length, which is at least 95% complementary, such as fully complementary, to a mammalian A1CF target nucleic acid, in particular a human A1CF nucleic acid.
  • These nucleic acid molecules are capable of inhibiting the expression of A1CF mRNA and/or protein.
  • An aspect of the invention relates to a nucleic acid molecule of 12 to 30 nucleotides in length, comprising a contiguous nucleotide sequence of at least 12 nucleotides, such as 12 to 30 nucleotides in length which is at least 90% complementary, such as fully complementary, to a mammalian A1CF target sequence.
  • a further aspect of the present invention relates to a nucleic acid molecule according to the invention comprising a contiguous nucleotide sequence of 14 to 22 nucleotides in length with at least 90% complementary, such as fully complementary, to the target sequence of SEQ ID NO: 1.
  • the nucleic acid molecule comprises a contiguous sequence of 12 to 30 nucleotides in length, which is at least 90% complementary, such as at least 91%, such as at least 92%, such as at least 93%, such as at least 94%, such as at least 95%, such as at least 96%, such as at least 97%, such as at least 98%, or 100% complementary with a region of the target nucleic acid or a target sequence.
  • the oligonucleotide, or contiguous nucleotide sequence thereof is fully complementary (100% complementary) to a region of the target sequence, or in some embodiments may comprise one or two mismatches between the oligonucleotide and the target sequence.
  • the oligonucleotide sequence is 100% complementary to a region of the target sequence of SEQ ID NO: 1 and/or SEQ ID NO: 4, 5, 6, 7, 8, 9, 10 and/or 11.
  • the nucleic acid molecule or the contiguous nucleotide sequence of the invention is at least 90% or 95% complementary, such as fully (or 100%) complementary, to the target nucleic acid of SEQ ID NO: 1 and/or 2.
  • the oligonucleotide or the contiguous nucleotide sequence of the invention is at least 90% or 95% complementary, such as fully (or 100%) complementary, to the target nucleic acid of SEQ ID NO: 2 and/or SEQ ID NO: 4, 5, 6, 7, 8, 9 10 and/or 11. In some embodiments, the oligonucleotide or the contiguous nucleotide sequence of the invention is at least 90% or 95% complementary, such as fully (or 100%) complementary, to the target nucleic acid of SEQ ID NO: 1 and/or SEQ ID NO: 2 and/or SEQ ID NO: 3.
  • the contiguous sequence of the nucleic acid molecule of the present invention is least 90% complementary, such as fully complementary to a region of SEQ ID NO: 1 , selected from the group consisting of target regions 1 A to 2001 A as shown in Table 4.
  • the contiguous sequence of the nucleic acid molecule of the present invention is least 90% complementary, such as fully complementary to a region of SEQ ID NO: 1, selected from the group consisting of target regions 1C to 178C as shown in Table 5.
  • the nucleic acid molecule of the invention comprises or consists of 12 to 60 nucleotides in length, such as from 13 to 50, such as from 14 to 35, such as 15 to 30, such as from 16 to 22 contiguous nucleotides in length.
  • the nucleic acid molecule comprises or consists of 15, 16, 17, 18, 19, 20, 21 or 22 nucleotides in length.
  • the contiguous nucleotide sequence of the nucleic acid molecule which is complementary to the target nucleic acids comprises or consists of 12 to 30, such as from 13 to 25, such as from 15 to 23, such as from 16 to 22, contiguous nucleotides in length.
  • the oligonucleotide is selected from the group consisting of an antisense oligonucleotide, an siRNA and a shRNA.
  • the contiguous nucleotide sequence of the siRNA or shRNA which is complementary to the target sequence comprises or consists of 18 to 28, such as from 19 to 26, such as from 20 to 24, such as from 21 to 23, contiguous nucleotides in length.
  • the contiguous nucleotide sequence of the antisense oligonucleotide which is complementary to the target nucleic acids comprises or consists of 12 to 22, such as from 14 to 20, such as from 16 to 20, such as from 15 to 18, such as from 16 to 18, such as from 16, 17, 18, 19 or 20 contiguous nucleotides in length.
  • the oligonucleotide or contiguous nucleotide sequence comprises or consists of a sequence selected from the group consisting of sequences listed in Table 6 (Materials and Methods section).
  • contiguous oligonucleotide sequence can be modified to, for example, increase nuclease resistance and/or binding affinity to the target nucleic acid.
  • oligonucleotide design The pattern in which the modified nucleosides (such as high affinity modified nucleosides) are incorporated into the oligonucleotide sequence is generally termed oligonucleotide design.
  • the nucleic acid molecule of the invention may be designed with modified nucleosides and RNA nucleosides (in particular for siRNA and shRNA molecules) or DNA nucleosides (in particular for single stranded antisense oligonucleotides).
  • the nucleic acid molecule or contiguous nucleotide sequence comprises one or more sugar modified nucleosides, such as 2’ sugar modified nucleosides, such as comprise one or more 2’ sugar modified nucleoside independently selected from the group consisting of 2’-O-alkyl-RNA, 2’-O-methyl-RNA, 2’-alkoxy-RNA, 2’-O-methoxyethyl-RNA, 2’-amino-DNA, 2’-fluoro-DNA, arabino nucleic acid (ANA), 2’-fluoro-ANA and LNA nucleosides. It is advantageous if one or more of the modified nucleoside(s) is a locked nucleic acid (LNA).
  • LNA locked nucleic acid
  • the contiguous nucleotide sequence comprises LNA nucleosides.
  • the contiguous nucleotide sequence comprises LNA nucleosides and DNA nucleosides.
  • the contiguous nucleotide sequence comprises 2’-O-methoxyethyl (2’MOE) nucleosides.
  • the contiguous nucleotide sequence comprises 2’-O-methoxyethyl (2’MOE) nucleosides and DNA nucleosides.
  • the 3’ most nucleoside of the antisense oligonucleotide, or contiguous nucleotide sequence thereof is a 2’sugar modified nucleoside.
  • the nucleic acid molecule comprises at least one modified internucleoside linkage. Suitable internucleoside modifications are described in the “Definitions” section under “Modified internucleoside linkage”.
  • the oligonucleotide comprises at least one modified internucleoside linkage, such as phosphorothioate or phosphorodithioate.
  • At least one internucleoside linkage in the contiguous nucleotide sequence is a phosphodiester internucleoside linkages.
  • the internucleoside linkages within the contiguous nucleotide sequence are phosphorothioate internucleoside linkages.
  • all the internucleotide linkages in the contiguous sequence of the single stranded antisense oligonucleotide are phosphorothioate linkages.
  • the antisense oligonucleotide of the invention is capable of recruiting RNase H, such as RNase H1 .
  • An advantageous structural design is a gapmer design as described in the “Definitions” section under for example “Gapmer”, “LNA Gapmer” and “MOE gapmer”.
  • the antisense oligonucleotide of the invention is a gapmer with an F-G-F’ design.
  • the F-G-F’ design may further include region D’ and/or D” as described in the “Definitions” section under “Region D’ or D” in an oligonucleotide”.
  • nucleic acid molecules such as the antisense oligonucleotide, siRNA or shRNA, of the invention can be targeted directly to the liver by covalently attaching them to a conjugate moiety capable of binding to the asialoglycoprotein receptor (ASGPr), such as divalent or trivalent GalNAc cluster.
  • ASGPr asialoglycoprotein receptor
  • liver targeting moieties are selected from moieties comprising cholesterol or other lipids or conjugate moieties capable of binding to the asialoglycoprotein receptor (ASGPR).
  • ASGPR asialoglycoprotein receptor
  • the invention provides a conjugate comprising a nucleic acid molecule of the invention covalently attached to a conjugate moiety.
  • the asialoglycoprotein receptor (ASGPR) conjugate moiety comprises one or more carbohydrate moieties capable of binding to the asialoglycoprotein receptor (ASPGR targeting moieties) with affinity equal to or greater than that of galactose.
  • ASPGR targeting moieties capable of binding to the asialoglycoprotein receptor
  • the affinities of numerous galactose derivatives for the asialoglycoprotein receptor have been studied (see for example: Jobst, S.T. and Drickamer, K. JB.C. 1996, 271, 6686) or are readily determined using methods typical in the art.
  • the conjugate moiety comprises at least one asialoglycoprotein receptor targeting moiety selected from group consisting of galactose, galactosamine, N-formyl- galactosamine, N-acetylgalactosamine, N-propionyl-galactosamine, N-n-butanoyl- galactosamine and N-isobutanoylgalactosamine.
  • the asialoglycoprotein receptor targeting moiety is N-acetylgalactosamine (GalNAc).
  • the ASPGR targeting moieties can be attached to a conjugate scaffold.
  • the ASPGR targeting moieties can be at the same end of the scaffold.
  • the conjugate moiety consists of two to four terminal GalNAc moieties linked to a spacer which links each GalNAc moiety to a brancher molecule that can be conjugated to the antisense oligonucleotide.
  • the conjugate moiety is mono-valent, di-valent, tri-valent or tetra-valent with respect to asialoglycoprotein receptor targeting moieties.
  • the asialoglycoprotein receptor targeting moiety comprises N-acetylgalactosamine (GalNAc) moieties.
  • GalNAc conjugate moieties can include, for example, those described in WO 2014/179620 and WO 2016/055601 and PCT/EP2017/059080 (hereby incorporated by reference), as well as small peptides with GalNAc moieties attached such as Tyr-Glu-Glu-(aminohexyl GalNAc)3 (YEE(ahGalNAc)3; a glycotripeptide that binds to asialoglycoprotein receptor on hepatocytes, see, e.g., Duff, et al., Methods Enzymol, 2000, 313, 297); lysine-based galactose clusters (e.g., L3G4; Biessen, et al., Cardovasc. Med., 1999, 214); and cholane-based galactose clusters (e.g., carbohydrate recognition motif for asialoglycoprotein receptor).
  • YEE(ahGalNAc)3 a glycotripeptide that
  • the ASGPR conjugate moiety in particular a trivalent GalNAc conjugate moiety, may be attached to the 3'- or 5'-end of the oligonucleotide using methods known in the art. In one embodiment, the ASGPR conjugate moiety is linked to the 5’-end of the oligonucleotide.
  • the conjugate moiety is a tri-valent N-acetylgalactosamine (GalNAc), such as those shown in Figure 1.
  • the conjugate moiety is the tri-valent N- acetylgalactosamine (GalNAc) of Figure 1A-1 or Figure 1A-2, or a mixture of both.
  • the conjugate moiety is the tri-valent N-acetylgalactosamine (GalNAc) of Figure 1B-1 or Figure 1B-2, or a mixture of both.
  • the conjugate moiety is the tri- valent N-acetylgalactosamine (GalNAc) of Figure 1C-1 or Figure 1C-2, or a mixture of both.
  • the conjugate moiety is the tri-valent N-acetylgalactosamine (GalNAc) of Figure 1 D-1 or Figure 1 D-2, or a mixture of both.
  • the invention provides methods for manufacturing the oligonucleotides of the invention comprising reacting nucleotide units and thereby forming covalently linked contiguous nucleotide units comprised in the oligonucleotide.
  • the method uses phophoramidite chemistry (see for example Caruthers et al, 1987, Methods in Enzymology vol. 154, pages 287- 313).
  • the method further comprises reacting the contiguous nucleotide sequence with a conjugating moiety (ligand) to covalently attach the conjugate moiety to the oligonucleotide.
  • composition of the invention comprising mixing the oligonucleotide or conjugated oligonucleotide of the invention with a pharmaceutically acceptable diluent, solvent, carrier, salt and/or adjuvant.
  • the compounds according to the present invention may exist in the form of their pharmaceutically acceptable salts.
  • pharmaceutically acceptable salt refers to conventional acid-addition salts or base-addition salts that retain the biological effectiveness and properties of the compounds of the present invention.
  • the invention provides a pharmaceutically acceptable salt of the nucleic acid molecules or a conjugate thereof, such as a pharmaceutically acceptable sodium salt, ammonium salt or potassium salt.
  • the invention provides pharmaceutical compositions comprising any of the compounds of the invention, in particular the aforementioned nucleic acid molecules and/or nucleic acid molecule conjugates or salts thereof and a pharmaceutically acceptable diluent, carrier, salt and/or adjuvant.
  • a pharmaceutically acceptable diluent includes phosphate-buffered saline (PBS) and pharmaceutically acceptable salts include, but are not limited to, sodium and potassium salts.
  • the pharmaceutically acceptable diluent is sterile phosphate buffered saline.
  • the nucleic acid molecule is used in the pharmaceutically acceptable diluent at a concentration of 50 to 300 pM solution.
  • Suitable formulations for use in the present invention are found in Remington's Pharmaceutical Sciences, Mack Publishing Company, Philadelphia, Pa., 17th ed., 1985. For a brief review of methods for drug delivery, see, e.g., Langer (Science 249:1527-1533, 1990).
  • WO 2007/031091 provides further suitable and preferred examples of pharmaceutically acceptable diluents, carriers and adjuvants (hereby incorporated by reference).
  • Suitable dosages, formulations, administration routes, compositions, dosage forms, combinations with other therapeutic agents, pro-drug formulations are also provided in W02007/031091.
  • the nucleic acid molecule or the nucleic acid molecule conjugates of the invention, or pharmaceutically acceptable salt thereof is in a solid form, such as a powder, such as a lyophilized powder.
  • compositions and methods for the formulation of pharmaceutical compositions are dependent upon a number of criteria, including, but not limited to, route of administration, extent of disease, or dose to be administered.
  • compositions may be sterilized by conventional sterilization techniques, or may be sterile filtered.
  • the resulting aqueous solutions may be packaged for use as is, or lyophilized, the lyophilized preparation being combined with a sterile aqueous carrier prior to administration.
  • the pH of the preparations typically will be between 3 and 11 , more preferably between 5 and 9 or between 6 and 8, and most preferably between 7 and 8, such as 7 to 7.5.
  • the resulting compositions in solid form may be packaged in multiple single dose units, each containing a fixed amount of the above-mentioned agent or agents, such as in a sealed package of tablets or capsules.
  • the composition in solid form can also be packaged in a container for a flexible quantity, such as in a squeezable tube designed for a topically applicable cream or ointment.
  • the nucleic acid molecule or nucleic acid molecule conjugate of the invention is a prodrug.
  • the conjugate moiety is cleaved off the nucleic acid molecule once the prodrug is delivered to the site of action, e.g. the target cell.
  • the compounds, nucleic acid molecules or nucleic acid molecule conjugates or pharmaceutical compositions of the present invention may be administered topically or enterally or parenterally (such as, intravenous, subcutaneous, or intra-muscular).
  • the oligonucleotide or pharmaceutical compositions of the present invention are administered by a parenteral route including intravenous, intraarterial, subcutaneous, intraperitoneal or intramuscular injection or infusion.
  • the active nucleic acid molecule or nucleic acid molecule conjugate is administered intravenously.
  • the active nucleic acid molecule or nucleic acid molecule conjugate is administered subcutaneously.
  • the nucleic acid molecule, nucleic acid molecule conjugate or pharmaceutical composition of the invention is administered at a dose of 0.1 - 15 mg/kg, such as from 0.2 - 10 mg/kg, such as from 0.25 - 5 mg/kg.
  • the administration can be once a week, every second week, every third week or even once a month.
  • the invention also provides for the use of the nucleic acid molecule or nucleic acid molecule conjugate of the invention as described for the manufacture of a medicament wherein the medicament is in a dosage form for subcutaneous administration.
  • the inhibitor of the present invention such as the nucleic acid molecule, nucleic acid molecule conjugate or pharmaceutical composition of the invention is for use in a combination treatment with another therapeutic agent.
  • the therapeutic agent can for example be the standard of care for the diseases or disorders described above.
  • the nucleic acid molecule or the nucleic acid molecule conjugate of the present invention may be used in combination with other actives, such as oligonucleotide-based antivirals - such as sequence specific oligonucleotide-based antivirals - acting either through antisense (including other LNA oligomers), siRNAs (such as ARC520), aptamers, morpholinos or any other antiviral, nucleotide sequence-dependent mode of action.
  • actives such as oligonucleotide-based antivirals - such as sequence specific oligonucleotide-based antivirals - acting either through antisense (including other LNA oligomers), siRNAs (such as ARC520), aptamers, morpholinos or any other antiviral, nucleotide sequence-dependent mode of action.
  • nucleic acid molecule or the nucleic acid molecule conjugate of the present invention may be used in combination with other actives, such as immune stimulatory antiviral compounds, such as interferon (e.g. pegylated interferon alpha), TLR7 agonists (e.g. GS-9620), or therapeutic vaccines.
  • immune stimulatory antiviral compounds such as interferon (e.g. pegylated interferon alpha), TLR7 agonists (e.g. GS-9620), or therapeutic vaccines.
  • nucleic acid molecule or the nucleic acid molecule conjugate of the present invention may be used in combination with other actives, such as small molecules, with antiviral activity.
  • actives such as small molecules, with antiviral activity.
  • these other actives could be, for example, nucleoside/nucleotide inhibitors (e.g. entecavir or tenofovir disoproxil fumarate), encapsidation inhibitors, entry inhibitors (e.g. Myrcludex B).
  • the additional therapeutic agent may be an HBV agent, a Hepatitis C virus (HCV) agent, a chemotherapeutic agent, an antibiotic, an analgesic, a nonsteroidal antiinflammatory (NSAID) agent, an antifungal agent, an antiparasitic agent, an anti-nausea agent, an anti-diarrheal agent, or an immunosuppressant agent.
  • HBV Hepatitis C virus
  • NSAID nonsteroidal antiinflammatory
  • an antifungal agent an antiparasitic agent
  • an anti-nausea agent an anti-diarrheal agent
  • an immunosuppressant agent may be an immunosuppressant agent.
  • the additional HBV agent may be interferon alpha-2b, interferon alpha-2a, and interferon alphacon-1 (pegylated and unpegylated), ribavirin; an HBV RNA replication inhibitor; a second antisense oligomer; an HBV therapeutic vaccine; an HBV prophylactic vaccine; lamivudine (3TC); entecavir (ETV); tenofovir diisoproxil fumarate (TDF); telbivudine (LdT); adefovir; or an HBV antibody therapy (monoclonal or polyclonal).
  • interferon alpha-2b, interferon alpha-2a, and interferon alphacon-1 pegylated and unpegylated
  • ribavirin an HBV RNA replication inhibitor
  • a second antisense oligomer an HBV therapeutic vaccine
  • an HBV prophylactic vaccine lamivudine (3TC); entecavir (ETV);
  • the additional HCV agent may be interferon alpha-2b, interferon alpha-2a, and interferon alphacon-1 (pegylated and unpegylated); ribavirin; pegasys; an HCV RNA replication inhibitor (e.g., ViroPharma's VP50406 series); an HCV antisense agent; an HCV therapeutic vaccine; an HCV protease inhibitor; an HCV helicase inhibitor; or an HCV monoclonal or polyclonal antibody therapy.
  • nucleic acid molecules of the invention may be utilized as research reagents for, for example, diagnostics, therapeutics and prophylaxis.
  • nucleic acid molecules may be used to specifically modulate the synthesis of A1CF protein in cells (e.g. in vitro cell cultures) and experimental animals thereby facilitating functional analysis of the target or an appraisal of its usefulness as a target for therapeutic intervention.
  • the target modulation is achieved by degrading or inhibiting the mRNA producing the protein, thereby preventing protein formation or by degrading or inhibiting a modulator of the gene or mRNA producing the protein.
  • the target nucleic acid may be a cDNA or a synthetic nucleic acid derived from DNA or RNA.
  • Also encompassed by the present invention is an in vivo or in vitro method for modulating A1CF expression in a target cell which is expressing A1CF, said method comprising administering a nucleic acid molecule, conjugate compound or pharmaceutical composition of the invention in an effective amount to said cell.
  • the target cell is a mammalian cell in particular a human cell.
  • the target cell may be an in vitro cell culture or an in vivo cell forming part of a tissue in a mammal.
  • the target cell is present in the liver.
  • the target cell may be a hepatocyte.
  • the A1CF inhibitor such as a nucleic acid molecule, conjugate compound or pharmaceutical composition of the invention is capable of reducing the cccDNA level in HBV infected cells and thereby inhibiting HBV infection.
  • the antisense oligonucleotide is capable of affecting one or more of the following parameters i) reducing cccDNA and/or ii) reducing pgRNA and/or iii) reducing HBV DNA and/or iv) reducing HBV viral antigens in an infected cell.
  • a nucleic acid molecule that inhibits HBV infection may reduce i) the cccDNA levels in an infected cell by at least 40% such as 50%, 60% or 70% reduction compared to controls; or ii) the level of pgRNA by at least 40% such as 50%, 60% or 70% reduction compared to controls.
  • the controls may be untreated cells or animals, or cells or animals treated with an appropriate control.
  • Inhibition of HBV infection may be measured in vitro using HBV infected primary human hepatocytes or in vivo using humanized hepatocytes PXB mouse model (available at PhoenixBio, see also Kakuni et al 2014 Int. J. Mol. Sci. 15:58-74).
  • Inhibition of secretion of HBsAg and/or HBeAg may be measured by ELISA, e.g. by using the CLIA ELISA Kit (Autobio Diagnostic) according to the manufacturers’ instructions.
  • Reduction of intracellular cccDNA or HBV mRNA and pgRNA may be measured by qPCR, e.g. as described in the Materials and Methods section.
  • Further methods for evaluating whether a test compound inhibits HBV infection are measuring secretion of HBV DNA by qPCR e.g. as described in WO 2015/173208 or using Northern Blot; in-situ hybridization, or immuno-fluorescence.
  • nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the present invention can be used to inhibit development of or in the treatment of HBV infection.
  • the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the present invention more efficiently inhibits development of or treats a chronic HBV infection as compared to a compound that only reduces secretion of HBsAg.
  • one aspect of the present invention is related to use of an A1CF inhibitor, such as the nucleic acid molecule, conjugate compounds or pharmaceutical compositions of the invention to reduce cccDNA and/or pgRNA in an HBV infected individual.
  • an A1CF inhibitor such as the nucleic acid molecule, conjugate compounds or pharmaceutical compositions of the invention to reduce cccDNA and/or pgRNA in an HBV infected individual.
  • a further aspect of the invention relates to the use of an A1CF inhibitor, such as the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the invention to inhibit development of or treat a chronic HBV infection.
  • an A1CF inhibitor such as the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the invention to inhibit development of or treat a chronic HBV infection.
  • a further aspect of the invention relates to the use of A1 CF inhibitor, such as the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the invention to reduce the infectiousness of a HBV infected person.
  • the A1 CF inhibitor such as the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the invention inhibits development of a chronic HBV infection.
  • the subject to be treated with the A1CF inhibitor such as the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the invention (or which prophylactically receives nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the present invention) is preferably a human, more preferably a human patient who is HBsAg positive and/or HBeAg positive, even more preferably a human patient that is HBsAg positive and HBeAg positive.
  • the present invention relates to a method of treating a HBV infection, wherein the method comprises administering an effective amount of A1CF inhibitor, such as the nucleic acid molecules, conjugate compounds or pharmaceutical compositions of the invention.
  • the present invention further relates to a method of preventing liver cirrhosis and hepatocellular carcinoma caused by a chronic HBV infection.
  • the A1CF inhibitors of the present invention is not intended for the treatment of hepatocellular carcinoma, only its prevention.
  • the invention also provides for the use of a A1CF inhibitor, such as nucleic acid molecule, a conjugate compound or a pharmaceutical composition of the invention for the manufacture of a medicament, in particular a medicament for use in the treatment of HBV infection or chronic HBV infection or reduction of the infectiousness of a HBV infected person.
  • a A1CF inhibitor such as nucleic acid molecule, a conjugate compound or a pharmaceutical composition of the invention for the manufacture of a medicament, in particular a medicament for use in the treatment of HBV infection or chronic HBV infection or reduction of the infectiousness of a HBV infected person.
  • the medicament is manufactured in a dosage form for subcutaneous administration.
  • the invention also provides for the use of a nucleic acid molecule, a conjugate compound, the pharmaceutical composition of the invention for the manufacture of a medicament wherein the medicament is in a dosage form for intravenous administration.
  • the A1 CF inhibitor such as the nucleic acid molecule, conjugate or the pharmaceutical composition of the invention may be used in a combination therapy.
  • the nucleic acid molecule, conjugate or the pharmaceutical composition of the invention may be combined with other anti-HBV agents such as interferon alpha-2b, interferon alpha-2a, and interferon alphacon-1 (pegylated and unpegylated), ribavirin, lamivudine (3TC), entecavir, tenofovir, telbivudine (LdT), adefovir, or other emerging anti-HBV agents such as a HBV RNA replication inhibitor, a HBsAg secretion inhibitor, a HBV capsid inhibitor, an antisense oligomer (e.g.
  • a siRNA e.g. described in WO 2005/014806, WO 2012/024170, WO 2012/2055362, WO 2013/003520, WO 2013/159109, WO 2017/027350 and W02017/015175
  • a HBV therapeutic vaccine e.g. described in WO 2005/014806, WO 2012/024170, WO 2012/2055362, WO 2013/003520, WO 2013/159109, WO 2017/027350 and W02017/015175
  • HBV therapeutic vaccine e.g. described in WO 2005/014806, WO 2012/024170, WO 2012/2055362, WO 2013/003520, WO 2013/159109, WO 2017/027350 and W02017/015175
  • HBV prophylactic vaccine e.g. described in WO 2013/003520, WO 2013/159109, WO 2017/027350 and W02017/015175
  • HBV antibody therapy monoclonal or polyclon
  • An A1 CF inhibitor for use in the in the treatment and/or prevention of Hepatitis B virus (HBV) infection.
  • A1 CF inhibitor for the use of embodiment 1 , wherein the A1 CF inhibitor is administered in an effective amount.
  • A1 CF inhibitor for the use of embodiments 1 to 3, wherein the A1 CF inhibitor is capable of reducing the amount of cccDNA and/or pgRNA in an infected cell.
  • A1 CF inhibitor for the use of any one of embodiments 1 to 4, wherein the A1 CF inhibitor prevents or reduces the association of A1CF protein to cccDNA.
  • A1 CF inhibitor for the use of any one of embodiments 1 to 7, wherein said inhibitor is a nucleic acid molecule of 12-60 nucleotides in length comprising or consisting of a contiguous nucleotide sequence of at least 12 nucleotides in length which is at least 90% complementary to a mammalian A1CF target nucleic acid.
  • A1 CF inhibitor for the use of embodiment 8 or 9, wherein the mammalian A1 CF target nucleic acid is RNA.
  • A1 CF inhibitor for the use of any one of embodiments 8 to 11 , wherein the nucleic acid molecule is selected from the group consisting of antisense oligonucleotide, siRNA and shRNA.
  • A1 CF inhibitor for the use of any one of embodiments 8 to 18, wherein the amount of mammalian A1CF target nucleic acid is reduced by at least 50%, such as 60% when compared to a control.
  • a nucleic acid molecule of 12 to 60 nucleotides in length which comprises or consists of a contiguous nucleotide sequence of 12 to 30 nucleotides in length wherein the contiguous nucleotide sequence is at least 90% complementary, such as 95%, such as 98%, such as fully complementary, to a mammalian A1CF target nucleic acid.
  • nucleic acid molecule of embodiment 20 or 21 wherein the mammalian A1CF target nucleic acid is selected from the group consisting of SEQ ID NO: 1, 4, 5, 6, 7, 8, 9,10 and 11.
  • the nucleic acid molecule of embodiment 20 or 21 wherein the contiguous nucleotide sequence is at least 98% complementary, such as fully complementary to the target nucleic acid of SEQ ID NO: 1 and SEQ ID NO: 2.
  • the nucleic acid molecule of embodiment 20 or 21 wherein the contiguous nucleotide sequence is fully complementary to the target nucleic acid of SEQ ID NO: 1 and SEQ ID NO: 2 and SEQ ID NO: 3.
  • the nucleic acid molecule of embodiment 31 wherein the contiguous nucleotide sequence comprises or consists of 16 to 20 nucleotides.
  • the nucleic acid molecule of embodiment 36, wherein the contiguous nucleotide sequence is fully complementary to the mammalian A1CF target nucleic acid.
  • nucleic acid molecule of any one of embodiments 20 to 39 comprising one or more modified nucleosides.
  • the nucleic acid molecule of embodiment 40 wherein the one or more modified nucleosides are high-affinity modified nucleosides.
  • the nucleic acid molecule of embodiment 40 or 41 wherein the one or more modified nucleosides are 2’ sugar modified nucleosides.
  • nucleic acid molecule of embodiment 42 wherein the one or more 2’ sugar modified nucleosides are independently selected from the group consisting of 2’-O-alkyl-RNA, 2’-O- methyl-RNA, 2’-alkoxy-RNA, 2’-O-methoxyethyl-RNA, 2’-amino-DNA, 2’-fluoro-DNA, 2’- fluoro-ANA and LNA nucleosides.
  • the nucleic acid molecule of any one of embodiments 40 to 43, wherein the one or more modified nucleosides are LNA nucleosides.
  • the nucleic acid molecule of embodiment 44 wherein the modified LNA nucleosides are selected from the group consisting of oxy-LNA, amino-LNA, thio-LNA, cET, and ENA.
  • the nucleic acid molecule of embodiment 48 wherein the cET is (S)cET, i.e. 6’(S)methyl- beta-D-oxy-LNA.
  • the nucleic acid molecule of any one of embodiments 20 to 50, wherein the nucleic acid molecule comprises at least one modified internucleoside linkage.
  • the nucleic acid molecule of embodiment 51 wherein the at least one modified internucleoside linkage is a phosphorothioate internucleoside linkage.
  • the nucleic acid molecule of embodiment 54, wherein the antisense oligonucleotide or contiguous nucleotide sequence thereof consists of or comprises a gapmer of formula 5’-F- G-F’-3’, where region F and F’ independently comprise or consist of 1-42’ sugar modified nucleosides and G is a region between 6 and 18 nucleosides which are capable of recruiting RNase H.
  • nucleic acid molecule of embodiment 55 wherein the 1-42’ sugar modified nucleosides are independently selected from the group consisting of 2’-O-alkyl-RNA, 2’-O-methyl-RNA, 2’-alkoxy-RNA, 2’-O-methoxyethyl-RNA, 2’-amino-DNA, 2’-fluoro-DNA, arabino nucleic acid (ANA), 2’-fluoro-ANA and LNA nucleosides.
  • the nucleic acid molecule of embodiment 55 or 56, wherein one or more of the 1 -42’ sugar modified nucleosides in region F and F’ are LNA nucleosides.
  • the nucleic acid molecule of embodiment 57 wherein all the 2’ sugar modified nucleosides in region F and F’ are LNA nucleosides.
  • nucleic acid molecule of any one of embodiments 56 to 59, wherein region F and F’ consist of identical LNA nucleosides.
  • the nucleic acid molecule of any one of embodiments 56 to 60, wherein all the 2’ sugar modified nucleosides in region F and F’ are oxy-LNA nucleosides.
  • the nucleic acid molecule of any one of embodiments 55 to 61 , wherein the nucleosides in region G are DNA nucleosides.
  • the nucleic acid molecule of embodiment 63, where all the nucleosides in region G are DNA nucleosides.
  • a conjugate compound comprising a nucleic acid molecule according to any one of embodiments 20 to 64, and at least one conjugate moiety covalently attached to said nucleic acid molecule.
  • the conjugate compound of embodiment 65 wherein the nucleic acid molecule is a double stranded siRNA and the conjugate moiety is covalently attached to the sense strand of the siRNA.
  • the conjugate compound of embodiment 65 or 66, wherein the conjugate moiety is selected from carbohydrates, cell surface receptor ligands, drug substances, hormones, lipophilic substances, polymers, proteins, peptides, toxins, vitamins, viral proteins or combinations thereof.
  • the conjugate compound of embodiment 69, wherein the asialoglycoprotein receptor targeting moiety is N-acetylgalactosamine (GalNAc).
  • the conjugate compound of embodiment 69 or 70 wherein the conjugate moiety is monovalent, di-valent, tri-valent or tetra-valent with respect to asialoglycoprotein receptor targeting moieties.
  • the conjugate compound of embodiment 71 wherein the conjugate moiety consists of two to four terminal GalNAc moieties and a spacer linking each GalNAc moiety to a brancher molecule that can be conjugated to the antisense compound.
  • GalNAc tri-valent N-acetylgalactosamine
  • the conjugate compound of embodiment 78, wherein the linker is a physiologically labile linker.
  • the conjugate compound of embodiment 79 wherein the physiologically labile linker is nuclease susceptible linker.
  • the conjugate compound of any one of embodiments 65-81 which display improved cellular distribution between liver vs. kidney or improved cellular uptake into the liver of the conjugate compound as compared to an unconjugated nucleic acid.
  • a pharmaceutical composition comprising a nucleic acid molecule of any one of embodiments 20 to 64, a conjugate compound of any one of embodiments 65 to 82 or acceptable salts thereof and a pharmaceutically acceptable diluent, carrier, salt and/or adjuvant.
  • a method for identifying a compound that prevents, ameliorates and/or inhibits a hepatitis B virus (HBV) infection comprising: a. contacting a test compound with i. an A1CF polypeptide; or ii. a cell expressing A1CF; b. measuring the expression and/or activity of A1 CF in the presence or absence of said test compound; and c. identifying a compound that reduces the expression and/or activity A1 CF and reduces cccDNA.
  • HBV hepatitis B virus
  • An in vivo or in vitro method for modulating A1CF expression in a target cell which is expressing A1CF comprising administering the nucleic acid molecule of any one of embodiments 20 to 64, a conjugate compound any one of embodiments 65 to 82 or the pharmaceutical composition of embodiment 83 in an effective amount to said cell.
  • inventions 85 wherein the target cell is infected with HBV and the cccDNA in an HBV infected cell is reduced by at least 50%, or at least 60% in the HBV infected target cell compared to the level without any treatment or treated with a control.
  • a method for treating or preventing a disease, such as HBV infection comprising administering a therapeutically or prophylactically effective amount of the nucleic acid molecule any one of embodiments 20 to 64, a conjugate compound of any one of embodiments 65 to 82, or the pharmaceutical composition of embodiment 83 to a subject suffering from or susceptible to the disease.
  • a disease such as HBV infection
  • nucleic acid molecule of any one of embodiments 20 to 64, or the conjugate compound of any one of embodiments 65 to 82 for the preparation of a medicament for treatment or prevention of a disease, such as HBV infection, in a subject.
  • the pool of siRNA (ON-TARGETplus SMART pool siRNA Cat. No. LU-013576-02-0005, Dharmacon) contains four individual siRNA molecules targeting the sequences listed in the above table.
  • Oligonucleotide synthesis is generally known in the art. Below is a protocol which may be applied.
  • the oligonucleotides of the present invention may have been produced by slightly varying methods in terms of apparatus, support and concentrations used. Oligonucleotides are synthesized on uridine universal supports using the phosphoramidite approach on an Oligomaker 48 at 1 pmol scale. At the end of the synthesis, the oligonucleotides are cleaved from the solid support using aqueous ammonia for 5-16hours at 60°C. The oligonucleotides are purified by reverse phase HPLC (RP-HPLC) or by solid phase extractions and characterized by UPLC, and the molecular mass is further confirmed by ESI-MS.
  • RP-HPLC reverse phase HPLC
  • UPLC UPLC
  • the coupling of p-cyanoethyl- phosphoramidites is performed by using a solution of 0.1 M of the 5’-O-DMT-protected amidite in acetonitrile and DCI (4,5-dicyanoimidazole) in acetonitrile (0.25 M) as activator.
  • a phosphoramidite with desired modifications can be used, e.g. a C6 linker for attaching a conjugate group or a conjugate group as such.
  • Thiolation for introduction of phosphorthioate linkages is carried out by using xanthane hydride (0.01 M in acetonitrile/pyridine 9:1). Phosphordiester linkages can be introduced using 0.02 M iodine in THF/Pyridine/water 7:2:1. The rest of the reagents are the ones typically used for oligonucleotide synthesis.
  • conjugation For post solid phase synthesis conjugation a commercially available C6 aminolinker phorphoramidite can be used in the last cycle of the solid phase synthesis and after deprotection and cleavage from the solid support the aminolinked deprotected oligonucleotide is isolated.
  • the conjugates are introduced via activation of the functional group using standard synthesis methods.
  • the crude compounds are purified by preparative RP-HPLC on a Phenomenex Jupiter® C18 10 pm 150x10 mm column. 0.1 M ammonium acetate pH 8 and acetonitrile is used as buffers at a flow rate of 5 mL/min. The collected fractions are lyophilized to give the purified compound typically as a white solid.
  • Oligonucleotide and RNA target (phosphate linked, PO) duplexes are diluted to 3 mM in 500 ml RNase-free water and mixed with 500 ml 2x T m -buffer (200 mM NaCI, 0.2mM EDTA, 20 mM Na-phosphate, pH 7.0). The solution is heated to 95°C for 3 min and then allowed to anneal in room temperature for 30 min.
  • the duplex melting temperatures (T m ) are measured on a Lambda 40 UV/VIS Spectrophotometer equipped with a Peltier temperature programmer PTP6 using PE Templab software (Perkin Elmer). The temperature is ramped up from 20°C to 95°C and then down to 25°C, recording absorption at 260 nm. First derivative and the local maximums of both the melting and annealing are used to assess the duplex T m .
  • dHCGM Clonal growth medium
  • dHCGM is a DMEM medium containing 100 U/ml Penicillin, 100 pg/ml Streptomycin, 20 mM Hepes, 44 mM NaHCOs, 15 pg/ml L-proline, 0.25 pg/ml insulin, 50 nM Dexamethazone, 5 ng/ml EGF, 0.1 mM Asc-2P, 2% DMSO and 10% FBS (Ishida et al., 2015).
  • Cells were cultured at 37°C incubator in a humidified atmosphere with 5% CO2. Culture medium was replaced 24 h post-plating and every 2 days until harvest.
  • Fresh primary human hepatocytes were provided by PhoenixBio, Higashi-Hiroshima City, Japan (PXB-cells also described in Ishida et al 2015 Am J Pathol. 185(5): 1275-85) in 70,000 cells/well in 96-well plate format.
  • the PHH Upon arrival the PHH were infected with an MOI of 2GE using HepG2 2.2.15-derived HBV (batch Z12) by incubating the PHH cells with HBV in 4% (v/v) PEG in PHH medium for 16 hours.
  • the cells were then washed three times with PBS and cultured a humidified atmosphere with 5% CO2 in fresh PHH medium consisting of DMEM (GIBCO, Cat# 21885) supplemented with 10% (v/v) heat-inactivated fetal bovine serum (GIBCO, Cat# 10082), 2% (v/v) DMSO, 1% (v/v) Penicillin/Streptomycin (GIBCO, Cat# 15140-148), 20 mM HEPES (GIBCO, Cat# 1 SOSO- OSO), 44 mM NaHCOs (Wako, Cat# 195-14515), 15 pg/ml L-proline (MP-Biomedicals, Cat# 0219472825), 0.25 pg/ml Insulin (Sigma, Cat# 11882), 50nM Dexamethasone (Sigma, Cat# D8893), 5ng/ml EGF (Sigma, Cat# E9644), and 0.1 mM L-Ascorbic acid 2-phosphat
  • a transfection mixture was prepared with 2 pl of either negative control siRNA (stock concentration 1 pM), A1CF siRNA pool (stock concentration 1 pM), HBx control siRNA (stock concentration 0.12 pM) or H2O (NDC) with 18.2 pl OptiMEM® (Thermo Fisher Scientific Reduced Serum media) and 0.6 l Lipofectamine® RNAiMAX Transfection Reagent (Thermofisher Scientific catalog No. 13778). The transfection mixture was mixed and incubated at room temperature 5 minutes prior to transfection.
  • the medium Prior to transfection, the medium was removed from the PHH cells and replaced by 100 pl/well William’s E Medium + GlutaMAXTM (Gibco, #32551 ) supplemented with HepaRG supplement without P/S (Biopredic International, #ADD711C). 20 pl of transfection mix was added to each well yielding a final concentration of 16 nM for the negative control siRNA or A1 CF siRNA pool, or 1.92 nM for the HBx control siRNA and the plates gently rocked before placing into the incubator. The medium was replaced with PHH medium after 6 hours. The siRNA treatment was repeated on day 6 post-infection as described above. On day 8 post-infection the supernatants were harvested and stored at -20°C. HBsAg and HBeAg can be determined from the supernatants if desired.
  • HBV antigen expressionHBV antigen expression and secretion can be measured in the collected supernatants if desired.
  • the HBV propagation parameters, HBsAg and HBeAg levels, are measured using CLIA ELISA Kits (Autobio Diagnostic #CL0310-2, #CL0312-2), according to the manufacturer’s protocol. Briefly, 25pL of supernatant per well is transferred to the respective antibody coated microtiter plate and 25 pL of enzyme conjugate reagent is added. The plate is incubated for 60 min on a shaker at room temperature before the wells are washed five times with washing buffer using an automatic washer. 25 pL of substrate A and B were added to each well. The plates are incubated on a shaker for 10 min at room temperature before luminescence is measured using an EnVision® luminescence reader (Perkin Elmer).
  • the cell viability was measured on the supernatant free cells by the Cell Counting Kit - 8 (CCK8 from Sigma Aldrich, #96992).
  • CCK8 reagent was diluted 1 :10 in normal culture medium and 100 pl/well added to the cells. After 1h incubation in the incubator 80 pl of the supernatants were transferred to a clear flat bottom 96 well plate and read the absorbance at 450 nm. Absorbance values were normalized to the NDC which was set to 100% to calculate the relative cell viabilities.
  • the cells were washed with PBS once and then lysed with 50 pl/well lysis solution from the TaqMan® Gene Expression Cells-to-CTTM Kit (Thermo Fisher Scientific, #AM1729) and stored at -80°C.
  • HBB human hemoglobin beta
  • 2 pl undigested cell lysate 0.5 pl 20x HBV Taqman primer/probe (Life Technologies, #Pa03453406_s1, FAM-dye)
  • 0.5 pl 20x HBB Taqman® primer/probe Life Technologies, #Hs00758889_s1 , VIC-dye
  • 5 pl TaqMan® Fast Advanced Master Mix Applied Biosystems, #4444557
  • 2 pl DEPC-treated water were used. Technical triplicates were run for each sample.
  • the qRT-PCR was run on the QuantStudioTM K12 Flex with standard settings for the fast heating block (95°C for 20 seconds, then 40 cycles with 95°C for 1 second and 60°C for 20 seconds).
  • GUS B the TaqMan® RNA-to-CtTM 1-Step Kit (Life Technologies, #4392656) was used.
  • 2 pl undigested cell lysate 0.5 pl 20x A1CF Taqman primer/probe (Life Technologies, #Hs00205840_m1, FAM-dye), 0.5 pl 20x GUS B Taqman primer/probe (Life Technologies, #Hs00939627_m1, VIC-dye), 5 pl 2x TaqMan® RT-PCR Mix, 0.25 pl 40x TaqMan® RT Enzyme Mix and 1.75 pl DEPC-treated water were used.
  • Technical triplicates were run for each sample and minus RT controls included to evaluate potential amplification due to DNA present.
  • the qRT-PCR was run on the QuantStudioTM K12 Flex with 48C for 15min, 95°C for 10min, then 40 cycles with 95°C for 15 seconds and 60C for 60 seconds.
  • the A1 CF mRNA expression levels were analyzed using the comparative cycle threshold 2- AACt method normalized to the reference gene GUS B and to non-transfected cells. Primers used for GUS B RNA and target mRNA quantification are listed in Table 8. The expression levels are presented as % of the average no drug control samples (i.e. the lower the value the larger the inhibition/reduction).
  • Example 1 Measurement of the reduction of A1CF mRNA, HBV intracellular DNA and cccDNA in HBV infected PHH cells resulting from siRNA treatment
  • siRNA transfection HBV infected PHH cells were treated with the pool of siRNAs from Dharmacon (LU-013576-02- 0005, see Table 6) as described in the Materials and Methods section “siRNA transfection”.
  • A1CF mRNA, cccDNA and intracellular HBV DNA were measured by qPCR as described in the Materials and Methods section “Real-time PCR for measuring A1CF mRNA Expression” and “qRT-PCR for cccDNA and HBV DNA quantification”. The results are shown in Table 9 as % of the average no drug control samples (i.e. the lower the value the larger the inhibition/reduction).
  • Table 9 Effect on HBV parameters following knockdown of A1CF with pool of siRNA. Values are given as average of biological and technical triplicates.
  • the A1CF siRNA pool is capable of reducing A1CF mRNA, cccDNA as well as HBV DNA quite efficiently.
  • the positive control reduced intracellular HBV DNA as expected but had no effect on cccDNA.

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Abstract

La présente invention concerne un inhibiteur de A1CF destiné à être utilisé dans le traitement d'une infection par le VHB, en particulier une infection chronique par le VHB. L'invention concerne en particulier l'utilisation d'inhibiteurs de A1CF pour déstabiliser l'ADNccc, tel que l'ADNccc du VHB. L'invention concerne également des molécules d'acide nucléique qui sont complémentaires de A1CF et capables de réduire le taux d'un ARNm de A1CF. La présente invention concerne également une composition pharmaceutique et son utilisation dans le traitement d'une infection par le VHB.
PCT/EP2021/072985 2020-08-21 2021-08-19 Utilisation d'inhibiteurs de a1cf pour traiter une infection par le virus de l'hépatite b WO2022038211A2 (fr)

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